EHR Abuse and Compliance

December 14, 2012

A recent report issued by The Department of Health and Human Services Office of the Inspector General which indicated that CMS is failing in its efforts to confirm information reported by physicians and facilities before they receive incentive payments for attesting to Meaningful Use has sparked controversy among the healthcare community.  The report stated, “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,” It also added that, “Verifying self-reported information prior to payment could also reduce the need to identify and recover erroneous payments after they are made.”  With this in mind, many are now investigating the concept of audits prior to the payments and looking into what kind of (and how much) EHR abuse is actually occurring.  With approximately $4 billion already paid to healthcare professionals and entities adopting and using EHRs, it is essential that the government money used for this initiative be backed by strong evidence of compliance and technological advancement.

Despite the criticism from the recent report, CMS has already contracted with Figliozzi and Co., a New Jersey accounting firm, to audit those professionals and hospitals who receive payments from Medicare and/or Medicaid.  Physicians and hospitals are required to maintain supporting documentation to back up their claims of Meaningful Use.  American Medical News suggests that information such as computer screen shots demonstrating that EHR technology functions were enabled during the reporting period and documents that verify a security risk assessment was conducted be kept in the event you are subject to an audit.  In addition, it is important to maintain proof of possession of a certified EMR system. Overall, if something was claimed in order to receive a bonus payment, there should be corresponding support.  All professionals and facilities are subject to audits, putting the pressure on to maintain compliance.

With physicians standing to earn up to $44,000 for adopting EMRs and hospitals able to receive $2 million in its first year of adoption, some may see a monetary incentive for “faking” compliance.  For example, EHRs can be used to inappropriately charge more for services or bill for services that were not even provided.  The possibility of these instances and more prompted the Attorney General, Eric H. Holder, Jr., and The Secretary of Health and Human Services, Kathleen Sebelius, to write a letter warning hospitals of Medicare bill abuses.  The letter was sent out to five major hospital trade associations and brings up potential issues such as cloning medical records (repeating a patient’s information in another record) to increase reimbursement.  The letter also stated, “There are also reports that some hospitals may be using electronic health records to facilitate ‘upcoding’ of the intensity of care or severity of patients’ condition as a means to profit with no commensurate improvement in the quality of care.”  More information about this can be found in a NY Times article.

Although there are many ways in which physicians or hospitals can attempt to cheat the system, rest assured that those found to have committed fraud will face penalties including paying any money awarded in error back.  The letter stated, “There are troubling indications that some providers are using this technology to game the system, possibly to obtain payments to which they are not entitled. False documentation of care is not just bad patient care; it’s illegal.”

While Medicare is committed to the accurate and appropriate payment of incentives for Meaningful Use attestation, it is also concerned that the fear of excessive and detailed audits may detract from the widespread adoption of EMRs and delay the payments to providers for those complying with guidelines.  The balance between meeting audit requirements and encouraging EMR use will likely continue to be complicated with so much money at stake.  Should your organization be called upon for an audit, there are several resources you can look to, including EMR vendors, Regional Extension Centers, or consultants.

In the future, expect to hear much more regarding Meaningful Use audits and their aftermath.

Excite Health Partners Consulting
Excite Health Partners is pleased to provide electronic medical records services to healthcare organizations nationwide, including Meaningful Use and EMR consulting.  Contact us online to learn more about our solutions or call us at 877-803-5804.