OIG: CMS Overpaid Providers Millions in EHR Incentive Payments

The Department of Health and Human Services’ Office of Inspector General (OIG) recently released a report finding that the Centers for Medicare & Medicaid Services (CMS) overpaid some $729 million in Medicare electronic health record (EHR) incentive payments to eligible providers who did not comply with federal meaningful use requirements.

In its report, the OIG noted that the errors occurred because “sampled eligible providers did not maintain support for their attestations.” In addition, the report noted that “CMS conducted minimal documentation reviews, leaving the self-attestations of the EHR program vulnerable to abuse and misuse of federal funds.”

The 29-page report, issued this month and based on a sample of 100 eligible providers over a three-year span (May 2011 to June 2014), also found that CMS paid $2.3 million in inappropriate EHR incentive payments that were not in accordance with the program-year payment requirements when eligible providers switched between Medicare and Medicaid incentive programs. Specifically, OIG identified 471 electronic health record incentive payments that CMS made to eligible providers for the wrong payment year.

“These errors occurred because CMS did not have edits in place to ensure that EPs who switched from one program to the other were placed in the correct payment year upon switching,” the report stated.

These incentive payments were made as part of a program to promote the adoption of electric health records and to improve healthcare quality, safety and efficiency through the promotion of such technology. To receive incentive payments, eligible providers must attest that they meet program requirements by self-reporting data through CMS’s online system.

OIG has recommended that CMS do the following:

  • Recover $291,222 in payments made to the sampled EPs who did not meet meaningful use requirements.
  • Review EP incentive payments to determine which EPs did not meet meaningful use measures for each applicable program year to attempt recovery of the $729,424,395 in estimated inappropriate incentive payments.
  • Review a random sample of EPs’ documentation supporting their self-attestations to identify inappropriate incentive payments that may have been made after the audit period.
  • Educate EPs on proper documentation requirements.
  • Recover $2,344,680 in overpayments made to EPs after they switched programs.
  • Employ edits within the NLR system to ensure that an EP does not receive payments under both EHR incentive programs for the same program year.

For its part, CMS agreed with most of the OIG’s recommendations and stated that it has implemented targeted risk-based audits to strengthen program integrity and will continue to do so.

What does this mean for eligible providers? Well, given the OIG’s recommendations, we suspect that those in the sample group will have to come up with the money that the OIG says is owed. With CMS on notice, providers need to conduct additional self-auditing in the future.

The Health Law Offices of Anthony C. Vitale can assist the providers with regard to any EMR government audit and corresponding overpayment assessment. Give us a call at 305-358-4500 or send an email to info@vitalehealthlaw.com and let’s discuss how we might be able to assist you.

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The Health Law Offices of Anthony C. Vitale