- Medicare paid more than $700 million in EHR incentives to eligible professionals (EPs) who did not meet federal meaningful use (MU) requirements, a new HHS Office of Inspector General report concludes.
- The OIG looked at a random sample of 100 EPs who had received one or more payments between May 2011 and June 2014 and found 14 with payments totaling $291,222 that did not meet MU requirements. The OIG also identified 471 EHR incentive payments totaling $2.3 million that were made to EPs for the wrong payment year.
- The report calls for the CMS to recover the wrongful payments made to the sampled EPs, educate EPs on proper documentation of MU and strengthen EHR incentive program integrity safeguards.
Providers failed to meet MU requirements for several reasons: insufficient attestation support, inappropriate reported MU periods or insufficiently used certified EHR technology. The OIG also chided the CMS on its scant documentation reviews, which put the program at risk of abuse and misused funds.
Based on the sample size, OIG estimates CMS incorrectly paid $729.4 million in incentive payments during the audit period — or 12% of total payments.
The wrong-year payments occurred because the CMS didn't ensure that EPs who switched between Medicare and Medicaid incentive programs were paid for the correct payment year after switching.
With the CMS on notice to prevent overpayments, providers and hospitals will need to do more careful self-auditing moving forward. The sample group will also need to cough up the improper payments they received — a strong incentive to bring documentation up to federal standards.
This isn’t the first time providers have received undeserved EHR incentive payments. A 2014 OIG audit found that Louisiana wrongly paid $4.4 million to 20 hospitals in 2011. The finding was noteworthy because it represented 80% of hospitals analyzed by the OIG.
EHR vendors themselves have also recently been accused of fraud and misuse. Earlier this month, eClinicalWorks agreed to settle a False Claims Act case for $155 million. It was the first time the Department of Justice held an EHR vendor accountable for not meeting federal standards of patient safety and quality care, but is not likely to be the last.