A recent report by the Department of Health and Human Services Office of the Investigator General (OIG) (“Medicare Paid Hundreds of Millions in Electronic Health Record Incentive Payments That Did Not Comply With Federal Requirements,” (A-05-14-00047), June 2017) claims that an estimated $729,424,395 in erroneous electronic health record (EHR) “meaningful use” incentive payments have been made to hospitals and eligible professionals (EP) since the program began in 2011.
Through the Health Information Technology for Economic and Clinical Health Act (HITECH Act), enacted as part of the American Recovery and Reinvestment Act of 2009, P.L. No. 111-5, Medicare and Medicaid EHR incentive programs were established to promote the adoption of certified EHR technology and to improve health care quality, safety, and efficiency. Incentive payments can be made for up to five (5) years once a hospital or EP attests it meets the “meaningful use” of EHR criteria through self-reporting data to CMS. However, the report found that attesting EPs received incentive payments even if they did not maintain support for their attestations, inappropriately reported meaningful use periods, or insufficiently used certified EHR technology. Furthermore, the report claims CMS “conducted minimal documentation reviews of self-attestations, leaving the EHR program vulnerable to abuse and misuse of Federal funds.”
Additionally, overpayments were made to EPs who switched between the Medicare and Medicaid Incentive Programs. The Medicare Access and Children’s Health Insurance Program [CHIP] Reauthorization Act (MACRA) (P.L. No. 114-10), enacted in April 2016, renamed and replaced the Medicare EHR Incentive Program as “Advancing Care Information” under the new MeritBased Incentive Payment System (MIPS). As a result of MIPS, providers who qualify as EPs under both Medicare and Medicaid can switch between the Medicare and Medicaid incentive programs one time, but must maintain their payment year status upon transfer. The report found that 471 EPs who switched between programs were incorrectly paid a higher first-year payment rate, resulting in over $2 Million in overpayments. “These errors occurred because CMS did not have sufficient edits in place to determine which payment year an EP should be in after switching between incentive payment programs,” according to the OIG.
The report indicated current CMS measures may be inadequate for recoupment and to prevent similar errors in the future: “After reviewing CMS’s comments and having follow-up discussions with CMS officials, we maintain that the targeted risk-based audits are not capturing errors such as those identified in this report. We therefore continue to recommend that CMS review EP incentive payments to determine which EPs did not meet meaningful use requirements and attempt recovery of the estimated $729,424,395, as well as review a random sample of EPs’ documentation supporting their self-attestations to identify inappropriate incentive payments.”