OIG Report Calls For EHR Incentive Payment Audits

Posted on by Frank J. Rosello

A new report from the Office of Department of Health and Human Services, Office of Inspector General (OIG) might not entirely spill the meaningful use apple cart, but it certainly isn’t going to make things any easier. The Nov. 29 report is calling for random audits of doctors and hospitals prior to payout, to ensure they have qualified. It is also calling for EHR certification changes to allow for reporting of yes/no measures.

The meaningful use EHR incentive program, now in its second year, allows providers to self-declare that they have achieved a host of measures to qualify for their piece of the nearly $7 billion meaningful use incentive pie.

“CMS faces obstacles to overseeing the Medicare EHR incentive program that leave the program vulnerable to paying incentives to professionals and hospitals that do not fully meet the meaningful use requirements,” say OIG officials. “Currently, CMS has not implemented strong pre-payment safeguards, and its ability to safeguard incentive payments post-payment is also limited.”

For the study, OIG says it reviewed CMS’s oversight of professionals’ and hospitals’ self-reported meaningful use of certified EHR technology in 2011, the first year of the program. “To address our objective, we analyzed self-reported information to ensure it met program requirements,” officials say. “We also reviewed CMS’s audit planning documents, regulations, and guidance for the program, and conducted structured interviews with CMS staff regarding CMS’s oversight.”

OIG is recommending that CMS:

  • obtain and review supporting documentation from selected professionals and hospitals prior to payment to verify the accuracy of their self-reported information;
  • issue guidance with specific examples of documentation that professionals and hospitals should maintain to support their compliance.

CMS did not entirely agree. “Prepayment reviews would increase the burden on practitioners and hospitals and could delay incentive payments,” according to CMS officials. CMS will, however, be willing to issue guidance, they said.

Brian T. Cook, a spokesman for CMS told Healthcare IT News, “Protecting taxpayer dollars is our top priority and we have implemented aggressive procedures to hold providers accountable.”

“Making a false claim is a serious offense with serious consequences and we believe the overwhelming majority of doctors and hospitals take seriously their responsibility to honestly report their performance,” he said.

The OIG says the Office of the National Coordinator for Health Information Technology (ONC) may be contributing to CMS’s “oversight obstacles.” ONC requires certified EHR technology to be capable of producing reports on meaningful use by aggregating information from records in the system.

  • require that certified EHR technology be capable of producing reports for yes/no meaningful use measures where possible;
  • improve the certification process for EHR technology to ensure accurate EHR reports.

Within the written report, ONC agreed with all of OIG’s recommendations. ONC officials deferred further comments on the report to CMS.

Click here to access the OIG report.

Article written by Diana Manos, Senior Editor for Healthcare IT News

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