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OIG calls for EHR audits by CMS to prevent meaningful use fraud



January 13, 2013
Area(s) of Interest: Electronic Health Records Fraud & Abuse 

The Centers for Medicare & Medicaid Services (CMS) has paid roughly $4 billion to about 82,500 professionals and 1,500 hospitals for adopting and using certified electronic health record (EHR) technology, but according to the Department of Health and Human Services Office of Inspector General (OIG), CMS is not doing enough to ensure that the money goes to those actually achieving meaningful use of EHRs.


The OIG has criticized CMS for failing to confirm the information reported by physicians and facilities before sending out bonus payments. “Although CMS is not required to verify the accuracy of this information prior to payment, doing so would strengthen its oversight of the anticipated $6.6 billion in incentive payments,” the OIG said in a Nov. 28 report. “Verifying self-reported information prior to payment could also reduce the need to identify and recover erroneous payments after they are made.”


Physicians can earn up to $44,000 from Medicare or up to $63,750 from Medicaid by reporting that they met certain minimum objectives signifying “meaningful use” of EHRs. The agency is paying out annual lump-sum bonuses for meaningful use, but in 2015, federal law requires Medicare to start lowering rates paid to eligible physicians who do not use EHRs.


But CMS opposes the suggestion for enhanced prepayment reviews of meaningful use claims, said CMS Administrator Marilyn Tavenner in a memo to the OIG. CMS already has implemented certain prepayment verification protocols. For instance, it validates all EHR system certification numbers reported by physicians and hospitals.


“It would be particularly difficult to implement for providers after their first year of participation because the reporting period is an entire year, and all [meaningful use] attestations are received in a two-month period during which CMS would have to review supporting documentation,” Tavenner said. “To change this process and implement prepayment audits could significantly delay payments to providers.”


CMS contracted with the Garden City, N.Y., firm Figliozzi & Co. to conduct post payment audits of health professional that have received meaningful use bonuses. The OIG anticipates that it will analyze these audits at a later date.


CMS has taken steps to ensure physicians reporting meaningful use are using certified technology. For instance, the agency uses vendor lists of products sold to practices and reviews attestation statements to ensure the information matches those lists.


For more information on the meaningful use bonuses, see CMA’s fact sheet, “Federal EHR Incentive Programs: Stage 2 of Meaningful Use and Changes to Stage 1,” available free to members in CMA’s online resource library.

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