OIG Releases Report on $730 Million in Improper EHR Incentive Payments.

The Department of Health and Human Services (HHS) Office of Inspector General (OIG) recently released a report reviewing the Center for Medicare and Medicaid’s (CMS) payment of Medicare electronic health record (EHR) incentive payments. The Health Information Technology for Economic and Clinical Health Act (HITECH Act) established the Medicare and Medicaid EHR incentive programs to promote EHR usage. Additionally, the incentive programs were created 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 CMS online system.

Improper incentive payments are the primary risk to EHR incentive programs, as identified by the Government Accountability Officer (GAO). Furthermore, a previous OIG report describes numerous state and CMS hurdles in overseeing the Medicare and Medicaid EHR incentive payments. These hurdles allow for improper incentive payments to be made to EPs and hospitals that do not meet the federal requirements. As such, the OIG conducted the review to determine the sufficiency of CMS’s oversight of the Medicare EHR incentive program, and whether it made improper payments to EPs nationwide. The OIG reported that Medicare made an estimated $730 Million in improper electronic health record (EHR) Incentive Payments between May 2011 and June 2014.

The OIG reported the following findings:

• CMS did not always ensure that federal requirements were met when making EHR incentive payments to EPs;
• Based on the random review sample of EPs, the OIG estimated that CMS inappropriately paid $729.4 million (12 percent of the total $6 billion in EHR incentive payments) to EPs who did not meet meaningful use requirements. These errors occurred because the sampled EPs did not maintain support for their attestations;
• The self-attestation element of the EHR incentive programs were vulnerable to abuse and misuse of federal funds due to CMS’ minimal conduct of documentation reviews;
• Over $2.3 million in CMS payments did not meet the program-year payment requirements in instances where EPs switched between Medicare and Medicaid incentive programs. CMS lacked the edits to ensure that EPs who switched from one program to the other were placed in the correct payment year upon switching.

The OIG recommended that CMS:

1. Recover payments from those sampled EPs who did not meet meaningful use requirements;
2. Attempt recovery of the $729.4 million in estimated inappropriate incentive payments to EPs;
3. Recover $2.3 million in overpayments made to EPs after they switched between the Medicare and Medicaid incentive programs;
4. Identify inappropriate incentive payments that may have been made after the audit period by reviewing a random sample of EP self-attestation documentation;
5. Educate EPs about proper documentation requirements; and
6. Employ edits to prevent EPs from receiving payments from both Medicaid and Medicare EHR incentive programs in the same program year.

The OIG report is available at: https://oig.hhs.gov/oas/reports/region5/51400047.pdf.