California Healthline Daily Edition

Summaries of health policy coverage from major news organizations

Report: Federal Government Lacks Safeguards Against EHR Fraud

Despite investing billions of dollars to encourage health care providers to adopt electronic health records, the federal government has done little to ensure the technology is not being used to inflate costs and overbill patients, according to a report published Wednesday by HHS' Office of the Inspector General, the New York Times reports.

Under the 2009 federal economic stimulus package, health care providers who demonstrate meaningful use of certified EHR systems can qualify for Medicaid and Medicare incentive payments. Since the law took effect, the percentage of hospitals with basic EHRs has tripled, to 44%.

Report Faults Medicare's Lack of Guidance for Contractors

The report notes that the federal government has spent more than $22 billion encouraging the adoption of EHRs but has "directed less attention to addressing potential fraud and abuse." Further, the report stated that Medicare has provided its contractors "with limited guidance."

In particular, the report pinpointed an EHR function called "cloning," in which users can copy information from one document to another in order to reduce time spent inputting patient data.  However, critics note that the "cloning" function can be used to overcharge Medicare because providers can use the function to indicate that more extensive and costly treatment has taken place than actually occurred.

The finding echoed an HHS OIG analysis released last month that found that three-quarters of surveyed hospitals had no formal policy directing the use of copy-and-paste for EHRs.

Medicare Pledges To Combat Fraud, Bolster Guidance

In a response, CMS officials said that preventing fraud is a "top priority," adding, "We are working to create strong standards for validating [EHRs] to ensure that we allow beneficiaries to receive the care they need and at the same time protect taxpayers from fraud, waste and abuse."

However, CMS said that while it was bolstering its guidance for contractors, HHS OIG's recommendation that Medicare closely review changes to patient data to guard against fraud would not be appropriate in every situation (Abelson/Creswell, New York Times, 1/8).


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