Rename "CMS Office of Burden Reduction" to "1984 on Steroids"
Rename "CMS Office of Burden Reduction" to "1984 on Steroids"
The Issue
CMS Office of Burden Reduction and Health Informatics is a misnomer.
It has failed American Healthcare in its prior iteration' and has done little in the current iteration. #CMS1984onSteroids is part of CMS, "Centers for Medicare and Medicaid Services." The only services it provides are to Health Insurance Lobby.
United Healthcare Executive wrote: "Thank you again for being faithful and practical for those you serve!" in response to the CMS Manager's assistance in avoiding compliance with Federal Law, where no penalty for non-compliance with federal standards has been imposed EVER!
As ProPublica reporting colorfully demonstrated, CMS has been serving the interests of powerful lobbyists so that venture capital steals money from doctors.
https://twitter.com/propublica/status/1691014001382010882
https://www.propublica.org/article/the-hidden-fee-costing-doctors-millions-every-year
There are two worlds: (1) you pay your ticket or they take your car when speeding cameras catch you running 26 mph in a 20 mph zone, and (2) then there are $Billion insurance companies where they don't get a $25 ticket for violating every federal law multiplied by millions every year.
There are few standards in healthcare - 8 years after the deadline. Standards are not enforced. It is no wonder that patients can't find a primary care physician - physicians are being driven out of healthcare and overwhelmed by administrative 'nonsense'; patients can't get the prescribed medication. Patients incur billions in wrongfully denied services and are driven to bankruptcy. Meanwhile, no major healthcare insurance went bankrupt (except through incompetence) in the past 20 years.
The "National Standards Group" at CMS Office of Burden Reduction closes 80-90% of complaints against health insurance companies without investigation or enforcement under false pretense. #CMS1984onSteroids
CMS Office of Burden Reduction fails even at basic clerical work to provide a copy of the complaint with details about violations of federal law to the health plans, a violation of due process. #CMS1984onSteroids
The one standard that Congress mandated, a Health Plan ID (HPID), was canceled by the Office of Burden Reduction and Health Informatics because the "Health Insurance Lobby" didn't like standards - it's easier to violate the law when there are no standards. As a result, CMS does not know how to contact health plans that it "regulates."
CMS does not know how many health plans it regulates! In addition, without a national HPID, it is impossible to standardize electronic communications between health plans and other entities. Right now, one health plan can have different "Payor IDs" - that's as if you had two US Passports with different names and dates of birth - illegal! #CMS1984onSteroids
https://www.cms.gov/Regulations-and-Guidance/Administrative-Simplification/Unique-Identifier/HPID
The CMS Office of Burden Reduction has met and exceeded expectations in using Doublespeak. It has mastered Doublespeak to the point that George Orwell would be proud of.
The CMS Office of Burden Reduction earned the honor of being called "1984 on Steroids". #CMS1984onSteroids
The congressional mandate in the "Health Insurance Portability and Accountability Act of 1996" is to "combat waste, fraud, and abuse in health insurance and health care delivery, to promote the use of medical savings accounts, to improve access to long-term care services and coverage, to simplify the administration of health insurance" is unfulfilled 25 years later. #CMS1984onSteroids
https://aspe.hhs.gov/reports/health-insurance-portability-accountability-act-1996
The staff at CMS Office of Burden Reduction lie and misrepresent reality every day:
Failed to include many questions that they 'did not like":
There is rampant non-compliance with standards, and not a single penalty for non-compliance has been imposed in 8 years:
The statistics about enforcement of Federal regulations were so embarrassing that CMS removed the link to it from their website - but here it is - 80% are closed as "invalid" - these are typically submitted by VP-level individuals:
https://www.cms.gov/files/document/asettq4external-complaint-reports-2021.pdf
The American Medical Association adopted the following as its policy (CMS Administrative Requirements D-190.970):
Our AMA will:
(1) forcefully advocate that the Centers for Medicare and Medicaid Services (CMS) investigate all valid allegations of HIPAA Administrative simplification requirements thoroughly and offer transparency in its processes and decisions as required by the Administrative Procedure Act (APA);
(2) forcefully advocate that the CMS resolve all complaints related to the non-compliant payment methods, including opt-out virtual credit cards, charging processing fees for electronic claims and other illegal electronic funds transfer (EFT) fees;
(3) communicate its strong disapproval of the failure by the CMS Office of Burden Reduction to effectively enforce the HIPAA administrative simplification requirements as required by the law and its failure to impose financial penalties for non-compliance by health plans; and
(4) through legislation, regulation or other appropriate means, advocate for the prohibition of health insurers charging physicians and other providers to process claims and make payment.
The Medical Society of the State of New York adopted the following as a policy:
https://www.mssnypositionstatements.org/position-statements-100-00-199-99/
120.891 Enforcement of Administrative Simplification Requirements – CMS
The Medical Society of the State of New York takes the position that the AMA must advocate:
there is parity in the enforcement of the HIPAA Privacy Rule and #HIPAA Administrative Simplification requirements; and that the CMS imposes penalties on health plan violations of HIPAA with the same rigor it imposes penalties on healthcare providers for violations of MIPS and other requirements;
https://specialtydocs.org/wp-content/uploads/2020/07/Alliance-Letter-to-Mary-Greene-7.20.2020.pdf
the CMS investigates all valid allegations of HIPAA Administrative Simplification Requirements thoroughly and offers transparency in its processes and decisions as required by the Administrative Procedure Act (APA); and
the CMS resolves all complaints related to non-compliant payment methods including opt-out virtual credit cards and illegal EFT fees.
MSSNY strongly disapproves of the failure by the CMS Office of Burden Reduction to effectively enforce the HIPAA Administrative Simplification Requirements as required by the law and its failure to impose financial penalties for non-compliance by health plans. (HOD 2021-55)
The Issue
CMS Office of Burden Reduction and Health Informatics is a misnomer.
It has failed American Healthcare in its prior iteration' and has done little in the current iteration. #CMS1984onSteroids is part of CMS, "Centers for Medicare and Medicaid Services." The only services it provides are to Health Insurance Lobby.
United Healthcare Executive wrote: "Thank you again for being faithful and practical for those you serve!" in response to the CMS Manager's assistance in avoiding compliance with Federal Law, where no penalty for non-compliance with federal standards has been imposed EVER!
As ProPublica reporting colorfully demonstrated, CMS has been serving the interests of powerful lobbyists so that venture capital steals money from doctors.
https://twitter.com/propublica/status/1691014001382010882
https://www.propublica.org/article/the-hidden-fee-costing-doctors-millions-every-year
There are two worlds: (1) you pay your ticket or they take your car when speeding cameras catch you running 26 mph in a 20 mph zone, and (2) then there are $Billion insurance companies where they don't get a $25 ticket for violating every federal law multiplied by millions every year.
There are few standards in healthcare - 8 years after the deadline. Standards are not enforced. It is no wonder that patients can't find a primary care physician - physicians are being driven out of healthcare and overwhelmed by administrative 'nonsense'; patients can't get the prescribed medication. Patients incur billions in wrongfully denied services and are driven to bankruptcy. Meanwhile, no major healthcare insurance went bankrupt (except through incompetence) in the past 20 years.
The "National Standards Group" at CMS Office of Burden Reduction closes 80-90% of complaints against health insurance companies without investigation or enforcement under false pretense. #CMS1984onSteroids
CMS Office of Burden Reduction fails even at basic clerical work to provide a copy of the complaint with details about violations of federal law to the health plans, a violation of due process. #CMS1984onSteroids
The one standard that Congress mandated, a Health Plan ID (HPID), was canceled by the Office of Burden Reduction and Health Informatics because the "Health Insurance Lobby" didn't like standards - it's easier to violate the law when there are no standards. As a result, CMS does not know how to contact health plans that it "regulates."
CMS does not know how many health plans it regulates! In addition, without a national HPID, it is impossible to standardize electronic communications between health plans and other entities. Right now, one health plan can have different "Payor IDs" - that's as if you had two US Passports with different names and dates of birth - illegal! #CMS1984onSteroids
https://www.cms.gov/Regulations-and-Guidance/Administrative-Simplification/Unique-Identifier/HPID
The CMS Office of Burden Reduction has met and exceeded expectations in using Doublespeak. It has mastered Doublespeak to the point that George Orwell would be proud of.
The CMS Office of Burden Reduction earned the honor of being called "1984 on Steroids". #CMS1984onSteroids
The congressional mandate in the "Health Insurance Portability and Accountability Act of 1996" is to "combat waste, fraud, and abuse in health insurance and health care delivery, to promote the use of medical savings accounts, to improve access to long-term care services and coverage, to simplify the administration of health insurance" is unfulfilled 25 years later. #CMS1984onSteroids
https://aspe.hhs.gov/reports/health-insurance-portability-accountability-act-1996
The staff at CMS Office of Burden Reduction lie and misrepresent reality every day:
Failed to include many questions that they 'did not like":
There is rampant non-compliance with standards, and not a single penalty for non-compliance has been imposed in 8 years:
The statistics about enforcement of Federal regulations were so embarrassing that CMS removed the link to it from their website - but here it is - 80% are closed as "invalid" - these are typically submitted by VP-level individuals:
https://www.cms.gov/files/document/asettq4external-complaint-reports-2021.pdf
The American Medical Association adopted the following as its policy (CMS Administrative Requirements D-190.970):
Our AMA will:
(1) forcefully advocate that the Centers for Medicare and Medicaid Services (CMS) investigate all valid allegations of HIPAA Administrative simplification requirements thoroughly and offer transparency in its processes and decisions as required by the Administrative Procedure Act (APA);
(2) forcefully advocate that the CMS resolve all complaints related to the non-compliant payment methods, including opt-out virtual credit cards, charging processing fees for electronic claims and other illegal electronic funds transfer (EFT) fees;
(3) communicate its strong disapproval of the failure by the CMS Office of Burden Reduction to effectively enforce the HIPAA administrative simplification requirements as required by the law and its failure to impose financial penalties for non-compliance by health plans; and
(4) through legislation, regulation or other appropriate means, advocate for the prohibition of health insurers charging physicians and other providers to process claims and make payment.
The Medical Society of the State of New York adopted the following as a policy:
https://www.mssnypositionstatements.org/position-statements-100-00-199-99/
120.891 Enforcement of Administrative Simplification Requirements – CMS
The Medical Society of the State of New York takes the position that the AMA must advocate:
there is parity in the enforcement of the HIPAA Privacy Rule and #HIPAA Administrative Simplification requirements; and that the CMS imposes penalties on health plan violations of HIPAA with the same rigor it imposes penalties on healthcare providers for violations of MIPS and other requirements;
https://specialtydocs.org/wp-content/uploads/2020/07/Alliance-Letter-to-Mary-Greene-7.20.2020.pdf
the CMS investigates all valid allegations of HIPAA Administrative Simplification Requirements thoroughly and offers transparency in its processes and decisions as required by the Administrative Procedure Act (APA); and
the CMS resolves all complaints related to non-compliant payment methods including opt-out virtual credit cards and illegal EFT fees.
MSSNY strongly disapproves of the failure by the CMS Office of Burden Reduction to effectively enforce the HIPAA Administrative Simplification Requirements as required by the law and its failure to impose financial penalties for non-compliance by health plans. (HOD 2021-55)
Victory
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Petition created on July 2, 2022