Myth Buster: Qualified Entities can use Medicare claims data for commercial purposes.

MYTH:  Qualified Entities can use Medicare claims data for commercial purposes.

FACT: Qualified Entities are barred from using Medicare claims data for commercial purposes.

A “Qualified Entity or QE” is an organization approved by the Centers for Medicare & Medicaid Services (CMS) to produce performance reports on the quality and efficiency of health care providers and suppliers. The QE program was authorized by the Patient Protection and Affordable Care Act (ACA) to encourage provider performance measurement and public reporting using Medicare claims data and private payer claims data (e.g. health care billing information that is submitted for reimbursement).  Regulations put out by CMS clearly prohibit the use of Medicare claims data for commercial purposes, and therefore ban Qualified Entities from using the data for these purposes as well.  To learn more about how Qualified Entities can use Medicare claims data, please read our Myth Buster below.