Helaine Fingold Quoted in “2016 Audit Notices Highlight Growing Misclassification Issue”

AIS Health

Helaine I. Fingold, a Senior Counsel in the Health Care and Life Sciences practice, in the firm’s Baltimore office, was quoted in AIS Health, in “2016 Audit Notices Highlight Growing Misclassification Issue,” by Lauren Flynn Kelly.

Following is an excerpt:

The notices posted earlier this month to the CMS Parts C and D Enforcement Actions webpage indicate that the agency intends to impose CMPs totaling $7.3 million on 17 insurers for deficiencies uncovered in their 2016 program audits. While it’s difficult to compare the scope of the recently posted 2016 audit findings with the 2015 findings without having seen the full set of results published annually in CMS’s Part C and Part D Program Audit Annual Report, attorney Helaine Fingold points out that the size of the largest fine imposed dropped from about $3.1 million to $2.5 million and the average CMP was much lower at about $429,000.

Last year’s report indicated that CMS in 2015 and early 2016 imposed 25 enforcement actions on MA and Part D sponsors that included five intermediate sanctions and 20 CMPs totaling $10.3 million, with an average of $516,163 per CMP (MAN 9/29/16, p. 6). Fingold, who is senior counsel in the Health Care and Life Sciences practice at the law firm Epstein Becker Green, says the lower figures don’t necessarily mean that there were fewer issues identified and suggests they could have more to do with the makeup of the plans, since the amount of the CMP tends to be higher for larger plans.