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OIG Tells CMS to Recover Improper EHR Incentive Payments

Posted in Electronic Health Records, Home Healthcare, Hospitals and Institutions, Legislation and Public Policy, Medicare and Medicaid, Reimbursement Matters

A new report published by the Department of Health and Human Services’ Office of Inspector General (OIG) concludes that the Centers for Medicare & Medicaid Services (CMS) made an estimated $729.4 million in overpayments to eligible professionals (EPs) that did not comply with federal requirements for electronic health record (EHR) incentive payments. The OIG also identified overpayments in excess of $2.3 million to EPs who switched between Medicare and Medicaid incentive programs.

The Medicare and Medicaid EHR Incentive Programs were established to encourage the use of health information technology by offering incentive payments to EPs and hospitals who demonstrate “meaningful use” of certified EHR technology. To evaluate CMS’s oversight of the EHR Incentive Programs, the OIG reviewed a random sample of payments made to 100 EPs between May 2011 to June 2014, all payments made to EPs who switched between Medicare and Medicaid Incentive Programs during the period, and all payments to EPs who died during the period. The sample showed that CMS made payments to EPs who used inadequately certified technology and EPs that failed to demonstrate meaningful use. Specifically, EPs who received payments during the review period did not maintain adequate documentation to support their meaningful use attestations. The study also showed that EPs who switched between Medicaid and Medicare Programs received payments under both programs in the same year when they should have only received payment under one of the programs.

The OIG has recommended that CMS (i) recover $291,000 in payments made to the sampled EPs who did not meet meaningful use requirements; (ii) attempt to recover the estimated $729.4 million in inappropriate incentive payments; and (iii) recover $2.3 million in overpayments to the sampled EPs who switched between Medicare and Medicaid programs. As of June 2014, the end of the study period, Medicare had made approximately $6 billion in EHR incentive payments to EPs.

In response to the report, CMS has vowed to strengthen the integrity of the EHR Incentive Programs, including through the continued use of targeted risk-based audits. EPs receiving incentive payments should review documentation requirements to ensure they are prepared to adequately demonstrate meaningful use and compliance with federal requirements in the event of an audit.

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