Healthcare News & Insights

Feds warn doctors not to use health IT for Medicare fraud

Health IT can bring many benefits for organizations – including the opportunity to increase revenue through illegal means. 

In a recent letter, Attorney General Eric H. Holder Jr. and Department of Health and Human Services (HHS) Secretary Kathleen Sebelius warned healthcare providers that organizations using electronic health records and other technology to commit fraud when collecting Medicare reimbursements will be prosecuted.

According to the letter, which was sent to five major hospital trade groups, some providers are using electronic health records (EHRs) to commit improperly increase their Medicare reimbursements. The feds plan to crack down heavily on organizations who do so.

Some examples of what providers are doing include:

  • “Cloning” of medical records, in which information in one patient’s EHR is copied and pasted into other patients’ in order to increase reimbursements, and
  • “Upcoding,” in which providers upgrade the seriousness of patients’ conditions and the level of treatment supposedly performed.

The letter warns that the Centers for Medicare and Medicaid Services (CMS) will review billing through audits and conduct medical reviews to make sure services are being coded properly. The federal government has already stepped up its enforcement efforts to discover medical fraud, and prosecutions in 2011 were 75% higher than they were in 2008, Holder and Sebelius said.

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