Audit estimates that 12% of the $6 billion in electronic health record incentive payments made to hospitals, physicians and other “eligible professionals” under the HITECH Act did not comply with federal regulations.
Federal auditors say that $729.4 million in Medicare payments to incentivize rapid adoption of electronic health records did not comply with requirements for attesting meaningful use.
The Department of Health and Human Services’ Office of the Inspector General is urging the Centers for Medicare and Medicaid Services to conduct a thorough review of the incentive program that was created under 2009’s Health Information Technology for Economic and Clinical Health Act (HITECH Act) and attempt to recover improper payments.
CMS began issuing the incentive payments in 2011.
“On the basis of our sample results, we estimated that CMS inappropriately paid $729.4 million (12% of the total) in incentive payments to EPs (eligible professionals) who did not meet meaningful use requirements,” OIG said in its report.
“These errors occurred because sampled EPs did not maintain support for their attestations. Furthermore, CMS conducted minimal documentation reviews, leaving the self-attestations of the EHR program vulnerable to abuse and misuse of Federal funds.”
OIG’s review examined $6 billion in EHR incentive payments that Medicare made to more than 250,000 EPs from May, 2011 through June, 2014.
To establish their estimate, OIG auditors selected 100 EPs at random and reviewed their self-reported support for attestation of meaningful use. Auditors also reviewed payments made to deceased EPs and to EPs who switched between Medicare and Medicaid programs to determine whether Medicare made inappropriate payments during our audit period.
Of the 100 EPs randomly reviewed, 14 EPs with payments totaling $291,222 did not meet the meaningful use requirements because of insufficient attestation support, inappropriate reported meaningful use periods, or insufficiently used certified EHR technology, OIG said.
OIG recommended that CMS:
- Recover $291,000 in payments made to the sampled EPs who did not meet meaningful use requirements;
- Review EP incentive payments to determine which EPs did not meet meaningful use measures for each applicable program year to attempt recovery of the $729.4 million in estimated inappropriate incentive payments;
- Review a random sample of Eps’ documentation supporting their self-attestations to identify inappropriate incentive payments that may have been made after the audit period;
- Educate EPs on proper documentation requirements.
The audit also found that CMS also made EHR incentive payments totaling $2.3 million that were not in line with program-year payment requirements when EPs switched between Medicare and Medicaid incentive programs. OIG said these errors occurred because CMS did not have edits in place to ensure that EPs who switched from one program to the other were placed in the correct payment year upon switching.
OIG recommended that CMS recover $2.3 million in overpayments made to EPs after they switched programs, and use edits within the National Level Repository system to ensure that an EP does not receive payments under both EHR incentive programs for the same program year.
CMS concurred or partially concurred with all of the recommendations.
John Commins is the news editor for HealthLeaders.