The Department of Health and Human Services’ Office of Inspector General (OIG) conducted an audit of the Electronic Health Records (EHR) program and found that the multi-billion dollar program was vulnerable to fraud and misuse.
Under the EHR program, providers can qualify for Medicare and Medicaid incentive payments if they meaningfully use certified EHR technology. OIG’s biggest problem with the program is CMS’s method of verifying whether a professional or hospital actually complied with the EHR program requirements.
CMS determines a provider’s eligibility for a meaningful use payment based solely on self-reported information. CMS doesn’t verify the accuracy of the information prior to payment, according to OIG. Although CMS plans to conduct post-payment audits, OIG found that even these may not conclusively verify the accuracy of the meaningful use data.
OIG recommended that CMS conduct pre-payment verification of self-reported data. CMS rejected this recommendation because it would increase the burden on practitioners and hospitals and could delay incentive payments. OIG also recommended the CMS issue guidance with specific examples of documentation that professionals and hospitals should maintain to support their compliance.
As of September 2012, CMS has paid $4 billion to 82,535 professionals and 1,474 hospitals under the EHR program, and it expects to spend an estimated $6.6 billion between 2011 and 2016.
The full OIG audit is located here.
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