- Two U.S. senators are pressing CMS to collect the more than $700 million in EHR incentives paid to eligible healthcare professionals who did not meet federal meaningful use (MU) requirements, FierceHealthcare reports.
- In a letter to CMS Administrator Seema Verma, Sens. Orrin Hatch (R-Utah) and Chuck Grassley (R-Iowa) note the agency has made no commitment to recoup the money and demanded to know what plans it had to do so.
- A recent HHS Office of Inspector General report found that Medicare overpaid paid roughly $729 million to clinicians between May 2011 and June 2014. The estimate was based on a sample of 100 eligible professionals. Of those, 14 failed to meet MU but still received $291,222 in incentives.
The OIG asked CMS to recover the improper payments made to the sampled clinicians and educate practitioners on proper documentation of MU. Hatch and Grassley demanded the agency take action now.
“If CMS is capable of recovering taxpayer money that should not have been spent, the agency should take all reasonable steps to do so,” the senators say. “If it is incapable of fully recovering the money, Congress should know about those limitations.”
The senators are demanding that CMS:
- Provide an update on efforts to collect the $291,222 in improper payments detailed in the OIG report;
- Explain why the agency hasn't attempted to recover the estimated $729 million in overpayments;
- Discuss efforts to recover about $2.3 million in overpayments made to clinicians who switched between Medicare and Medicaid, resulting in payments being made for the wrong year;
- Review a sample of clinicians’ self-attestation documentation to identify improper payments made after the audit period;
- Explain how targeted-risk audits will help to recover improper payments and prevent future ones from occurring.
The providers who failed to meet MU requirements in the OIG sample mostly did so because of insufficient attestation support, lack of certified EHR technology or improperly reported MU periods.
Providers have frequently criticized the MU program for making requirements not in line with available technology and worsening reporting burdens. The federal government has been willing to relax or delay some of the requirements. The frustration from the senators shows the government may be slow to recover overpayments, but recent actions make it clear fraud and abuse will not be tolerated.
Hospitals and provider groups would be wise to self-audit and steer clear of poor documentation that can lead to improper payments or fraud accusations.
And providers aren't the only ones to run afoul of MU. Last month, EHR vendor cElinicalWorks and several of its employees agreed to pay the government $155 million to settle False Claims Act allegations regarding misrepresentation of software capabilities and $392,000 in kickbacks to customers who promoted the product.