Healthcare News & Insights

Report: EHR incentive program too easy to defraud

Could there be changes on the way for the federal EHR incentive program? A new government probe says the program doesn’t do enough to keep providers honest when applying for the program. 

Through the end of the November, the Centers for Medicare and Medicaid Services (CMS) estimates it’s given healthcare providers a total of $9.2 billion as incentives for switching to electronic health records (EHRs). The agency expects incentive payments to top $10 billion by the end of 2012.

However, that news comes shortly after the release of a report from the Inspector General’s office of the Department of Health and Human Services (HHS) which claimed that the federal EHR incentive program lacks sufficient oversight and could result in funds being given to organizations that don’t qualify.

As health IT pros know, to qualify for EHR incentives, providers must use certified EHR software and meet the appropriate meaningful use requirements. But the problem, according to the HHS report, is that CMS relies on healthcare organizations to self-report their compliance with the requirements.

Screening before incentives are paid consists only of doing the math to make sure the self-reported data meets the thresholds for percentage-based measures and making sure the provided answered “yes” for enough yes-or-no incentives, as wells as verifying that the EHR software the provider says it’s using is certified. CMS also plans to audit a select group of incentive recipients to make sure their data is accurate. However, though the meaningful use audit process began over the summer, no audits have been completed so far.

No verification of self-reported data

For the report, the Inspector General’s office collected self-reported data from participants in the Medicare incentive program. The study found that CMS does correctly identify which providers meet meaningful use requirements based on their self-reported information — however, the agency doesn’t do much to verify the accuracy of that information. According to the report, CMS doesn’t have access to enough external data that could be used to verify self-reported information.

While collecting more data from all applicants might not be feasible, the report suggests CMS choose applications to ask for more data, similar to how it will choose organizations audit — except before the payment is sent, rather than after. Also, HHS says the agency should give more clear guidance about what documents providers should keep and what reports EHR systems should be able to deliver.

Are any changes to the EHR incentive program likely to take place? While CMS agreed that more guidance is necessary regarding what documents should be saved, the agency also responded to report saying that asking for more evidence before delivering payments is unnecessary.

Get ready for meaningful use audits

Though the program may stay the same, one thing providers can do now is get ready for a meaningful use audit, since it seems like that will be CMS’s main way of keeping tabs on who’s receiving incentive funds.

Meaningful use audits will start with the provider sending CMS supporting documentation. Then, if that’s unsatisfactory, the agency will conduct an on-site audit. In July, several providers received letters notifying them they were being audited. According to the law firm Ober Kaler, the audit letters received asked providers for:

  • A copy of the certification for the EHR system that they’re using to meet Meaningful Use requirements
  • Documentation of the method they chose to report emergency department admissions (i.e., observation services or all emergency department visits), and
  • Documentation regarding their completion of Meaningful Use’s core and menu set objectives — presumably meaning information beyond what was already given to CMS as part of the attestation process.

While more guidance should be coming soon, CMS says to prepare for a possible audit, organizations attesting to meaningful use should retain all relevant documentation, in either electronic or paper form, for six years after the attestation.

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