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12 percent of the $6 billion in EHR incentive payments were improper
The HITECH Act established the electronic health record (EHR) incentive programs to promote the adoption of EHRs and to improve health care quality, safety, and efficiency through health information technology and electronic health information exchange. In furtherance of these programs, the federal government is making payments to eligible professionals (EPs) and hospitals that attest to the “meaningful use” of EHRs. To receive an incentive payment, EPs must attest that they meet program requirements by self-reporting data through the Centers for Medicare & Medicaid Services (CMS) online system.
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The OIG found that CMS did not always make EHR incentive payments to EPs in accordance with federal requirements. Based upon the OIG’s review sample, CMS inappropriately paid $729.4 million (12 percent of the total) in incentive payments to EPs who did not meet meaningful use requirements. The 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. The OIG also found that CMS made EHR incentive payments totaling $2.3 million that were not in accordance with the program-year payment requirements when EPs switched between Medicare and Medicaid incentive programs. 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. The OIG called for CMS to:
- Recover payments made to the sampled EPs who did not meet meaningful use requirements;
- Attempt recovery of the $729.4 million in estimated inappropriate incentive payments;
- Recover $2.3 million in overpayments made to EPs after they switched programs;
- Review a random sample of EP 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; and
- Employ edits to ensure that an EP does not receive payments under both EHR incentive programs for the same program year.
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