Inspector general: EHR incentive program needs better oversight

Report identifies potential issues with data used to determined payments

CMS and HHS need to strengthen oversight of Medicare's electronic health record (EHR) incentive payment program because of potential issues with the data that they use to determine payment eligibility and amount, according to a new report from HHS's Office of Inspector General (OIG).

Under the 2009 federal economic stimulus package, health care providers who demonstrate meaningful use of certified EHR systems can qualify for Medicare and Medicaid incentive payments. Between 2011 and 2016, CMS expects to make about $6.6 billion in incentive payments to physicians, hospitals, and other providers for implementing EHR systems that meet certain standards.

Report findings

For the report, OIG investigators analyzed audits of EHR incentive payment attestations, reviewed internal CMS and Office of the National Coordinator (ONC) for Health Information Technology documents about the program and interviewed CMS personnel. The report covered the period from May 2011 through December 2011, when about $1.7 billion in Medicare incentive payments were made to providers.

The investigators did not look at the Medicaid portion of the meaningful use program, which was the focus of a similar report issued in July 2011 that examined Medicaid payments to providers in 13 states.

According to the report, Medicare has not established adequate safeguards to ensure the accuracy of the data that providers report about their EHR systems. As a result, the incentive payment program is "vulnerable" to making incentive payments to providers who "do not fully meet the meaningful use requirements." Under the requirements, providers must show that the systems lead to better patient care.

The report noted that, although CMS officials are making sure that providers are checking off the necessary boxes in their submitted forms, officials are not taking additional steps to ensure that providers are providing truthful and accurate information. The agency also does not require physicians and hospitals to submit additional documentation illustrating evidence of their claims.

Although CMS has signaled that it will conduct audits after payments are made, no audits have been conducted to date, the report noted. Further, OIG investigators said that the incentive payment program lacks regulations specifying what kinds of documents health care providers and hospitals should retain in case they are audited.

The investigators also faulted ONC—which is responsible for certifying the EHR software systems that providers use to qualify for the Medicare incentive payment –for failing to ensure that the systems' reports are accurate and meet meaningful use standards.

OIG conclusions and recommendations

The report stated, "Although CMS is not required to verify the accuracy of this information prior to payment, doing so would strengthen its oversight" of the anticipated payments through 2016, adding, "Verifying self-reported information prior to payment could also reduce the need to identify and recover erroneous payments after they are made."

The report recommended that the agency strengthen its prepayment assessment program by randomly selecting "high-risk" providers and asking them to "submit supporting documentation for prepayment review." The report also called for clearer guidance on specific examples of documentation that providers and hospitals should maintain to prove their compliance with the meaningful use requirements.

OIG also proposed that ONC require that certified EHR systems be capable of producing reports on whether specific functions can be performed, as well as improve the EHR certification process to increase the likelihood that the reports are accurate.

CMS responds

However, Acting CMS Administrator Marilyn Tavenner disagreed with the recommendation for the prepayment reviews, noting that it "could significantly delay payments to providers" and "impose an increased upfront burden."

Meanwhile, a CMS spokesperson noted, "Protecting taxpayer dollars is our top priority, and we have implemented aggressive procedures to hold providers accountable," adding, "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" (Conn, Modern Healthcare, 11/29 [subscription required]; Abelson, New York Times, 11/29; Adams, CQ HealthBeat, 11/29 [subscription required]).

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