Scott R. Grubman, Esq. Gregory A. Tanner, Esq. Chilivis, Cochran, Larkins & Bever, LLP
On June 7, 2017, the Office of Inspector General (OIG) of the U.S. Department of Health and Human Services (HHS) released a report estimating that Medicare paid over $729 million in improper EHR incentive payments to healthcare providers who did not meet meaningful use requirements.
Established in 2009 as part of the HITECH Act, and now partially incorporated into the Merit-Based Incentive Payment System under MACRA, the Medicare and Medicaid EHR incentive programs were created to promote the adoption and use of EHR and other health information technology to improve healthcare quality, safety, and efficiency. Under these incentive programs, professionals such as physicians, dentists, podiatrists, optometrists and chiropractors could be eligible to receive incentive payments from Medicare by adopting EHR in their practices and meeting certain “meaningful use” requirements.
Between May 2011 and June 2014, Medicare paid over $6 billion to over 240,000 eligible providers. The OIG’s report was based on a random sample of 100 providers who had received at least one payment under the Medicare EHR incentive program. One issue the OIG found was that 12 of the sampled providers did not maintain or could not provide sufficient documentation to support their attestations that they had adopted required measures (e.g., did not provide a security risk assessment, or could not generate at least one report listing patients with a specific condition). The OIG also found that some providers had based their attestations on patient encounter data from periods less than a full calendar year, as was required. Additionally, according to the OIG, some providers incorrectly attested to having at least 50% of all patient encounters at a location equipped with a certified EHR, as was required.
Of the 100 providers audited, the OIG found that 14 of the 100 had inappropriately received incentive payments totaling $291,222. Extrapolating its findings, the OIG estimated that Medicare has made over $729 million in inappropriate incentive payments to providers. The OIG also disclosed that it has identified 471 providers who were overpaid a total over $2.3 million after switching between the Medicare and Medicaid EHR incentive programs (providers can only participate in one incentive payment program, and if they switch between the programs, then they can only switch once, but then are not eligible for the higher first-year incentive rate for both programs).
Find out more about what recommendations we made because of this report and what actionsyou, as physicians and healthcare practitioners, should take.