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OIG to Audit EHR Incentive Payments

Walter Eisner • Fri, August 11th, 2017

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If your practice receives incentive payments to use electronic health records (EHR), pay attention.

In June, the Department of Health and Human Services’ (HHS) Office of Inspector General (OIG) said Centers for Medicare and Medicaid Services (CMS) overpaid federal EHR incentive payments to providers by $729 million over the last six years. The OIG says providers did not meet Meaningful Use requirements.

Abuse and Misuse

The OIG said CMS failed to conduct minimal documentation reviews, which officials said left the incentive program open to abuse and misuse of federal funds. CMS also made $2.3 million in EHR incentive payments that didn't adhere to program-year payment requirements when providers switched from Medicaid to Medicare incentive programs. Officials said this is because CMS did not ensure those providers who switched programs were in the correct payment year.

In response to the June report, CMS said it's implemented targeted risk-based audits to strengthen the integrity of the program. But the OIG said targeted risk-based audits are not capturing errors such as those identified in the report.

The EHR industry was stung by a $155 million settlement between eClinicalWorks and the Department of Justice in May. The settlement followed allegations that the software company prompted fraudulent incentive payments by falsifying Meaningful Use certification.

OIG Audit

In a midyear update to its 2017 Work Plan, the OIG will do an audit and take another look at those payments.

The audit will focus on Medicare payments made to hospitals between 2011 and 2016, which total $14.6 billion. The agency points to several reviews of state Medicaid EHR incentive programs that identified $66.7 million in overpayments.

In addition to the EHR incentive program, OIG added a review of Medicare payments for telehealth services. The agency plans to release a report later this year that reviews Medicare claims for services provided at a distant site that don't include corresponding claims from the originating site.

OIG will continue to review:

  • The extent to which providers participating in accountable care organizations in the Medicare Shared Savings Program use EHRs to exchange health information to achieve care coordination goals and providers’ use of EHRs to identify best practices and possible challenges to exchange and use of health data, such as the degree of interoperability, financial barriers or information blocking
  • Medicare incentive payments and safeguards to prevent erroneous payments
  • Incentive payment data to identify providers who didn’t meet selected Meaningful Use Criteria
  • The Centers for Medicare & Medicaid Services' plans to oversee payments and corrective actions taken
  • Covered entities to determine whether they adequately protect EHR information created or maintained by certified EHR technology, specifically referencing the need to conduct security risk analyses

More to Come

More scrutiny over Meaningful Use and EHR may be on the way.

“Going forward, OIG’s planning efforts will consider the significant challenges that exist with respect to health IT adoption; Meaningful Use; and interoperability across providers, across HHS, and between providers and patients. Future work may also examine the outcomes from health IT investments. OIG expects to broaden its portfolio regarding information privacy and security, including issues that arise from the continuing expansion of the Internet of Things," stated an OIG statement.

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