Medicare EHR Incentive Program Vulnerable to Abuse, Report Finds
CMS and HHS need to strengthen their oversight of Medicare's electronic health record incentive payment program because of potential issues with the data that they use to determine payment eligibility and amount, according to a report by the HHS Office of Inspector General, Modern Healthcare reports (Conn, Modern Healthcare, 11/29).
Under the 2009 federal economic stimulus package, health care providers who demonstrate meaningful use of certified EHR systems can qualify for Medicare and Medicaid incentive payments (Abelson, New York Times, 11/29).
Between 2011 and 2016, CMS expects to make about $6.6 billion in incentive payments to physicians, hospitals and other providers for implementing EHR systems that meet certain standards.
Details of Report
For the report, OIG investigators analyzed audits of EHR incentive payment attestations, reviewed internal CMS and Office of the National Coordinator for Health Information Technology documents about the program and interviewed CMS personnel. The report covered the period from May 2011 through December 2011, when Medicare incentive payments totaling about $1.7 billion were made to providers.
The investigators did not look at the Medicaid portion of the meaningful use program, which was the focus of a similar report issued in July 2011 that examined Medicaid payments to providers in 13 states.
The Medicare payments during the eight-month period in 2011 were made to nearly 27,000 physicians and other eligible medical professionals and 668 hospitals (Modern Healthcare, 11/29). As of August 2012, CMS had paid out about $3.6 billion to 74,317 medical professionals and 1,333 hospitals, according to CQ HealthBeat (Adams, CQ HealthBeat, 11/29).
According to the report, Medicare has not established adequate safeguards to ensure the accuracy of the data that providers report about their EHR systems, the New York Times reports. As a result, the incentive payment program is "vulnerable" to making incentive payments to providers who "do not fully meet the meaningful use requirements." Under the requirements, providers must show that the systems lead to better patient care (New York Times, 11/29).
The report noted that although CMS officials are making sure that providers are checking off the necessary boxes in their submitted forms, the officials are not taking the additional steps to ensure that providers are providing truthful and accurate information. The agency also does not require physicians and hospitals to submit additional documentation illustrating evidence of their claims.
Although CMS has signaled that it will conduct audits after payments are made, no audits have been conducted to date, the report noted. Further, OIG investigators said that the incentive payment program lacks regulations specifying what kinds of documents health care providers and hospitals should retain in case they are audited (CQ HealthBeat, 11/29).
The investigators also faulted ONC -- which is responsible for certifying the EHR software systems that providers use to qualify for the Medicare incentive payments -- for failing to ensure that the systems' reports are accurate and meet meaningful use standards (New York Times, 11/29).
Report's Conclusion and Recommendations
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 payments through 2016, adding, "Verifying self-reported information prior to payment could also reduce the need to identify and recover erroneous payments after they are made" (CQ HealthBeat, 11/29).
The report recommended that the agency strengthen its prepayment assessment program by randomly selecting "high-risk" providers and asking them to "submit supporting documentation for prepayment review" (Modern Healthcare, 11/28). The report also called for clearer guidance on specific examples of documentation that providers and hospitals should maintain to prove their compliance with the meaningful use requirements.
OIG also proposed that ONC require that certified EHR systems be capable of producing reports on whether specific functions can be performed, as well as improve the EHR certification process to increase the likelihood that the reports are accurate (CQ HealthBeat, 11/29).
In a response to the report, CMS officials said they agreed with some of the recommendations and that they would clarify what providers and hospitals must do to qualify for incentive payments. ONC officials also said they already are working to improve the process of certifying systems.
However, Acting CMS Administrator Marilyn Tavenner disagreed with the recommendation for the prepayment reviews, noting that it "could significantly delay payments to providers" and "impose an increased upfront burden" (New York Times, 11/29).
Meanwhile, a CMS spokesperson noted, "Protecting taxpayer dollars is our top priority, and we have implemented aggressive procedures to hold providers accountable," adding, "Making a false claim is a serious offense with serious consequences and we believe the overwhelming majority of doctors and hospitals take seriously their responsibility to honestly report their performance" (CQ HealthBeat, 11/29).This is part of the California Healthline Daily Edition, a summary of health policy coverage from major news organizations. Sign up for an email subscription.