Based on an announcement from the Department of Health and Human Services' Office of Inspector General, the organization plans to review its incentive payments made to hospitals for adopting electronic health records. This means HHS is going to scrutinize meaningful use payments paid to health systems to see if it paid any funds inappropriately.
"We will review the hospitals' incentive payment calculations to identify potential overpayments that the hospitals would have received as a result of the inaccuracies," the OIG said.
This effort means expanded new and ongoing audit activities related to these payments. EHR incentive payments, totaling $14.6 billion, made from 2011 through 2016 by the Centers for Medicare and Medicaid Services, are the subject of the review. Auditors will issue a report of findings in the fiscal year 2018.
All of this is the result of bad optics after an HHS audit found that CMS paid $729.4 million in improper incentive payments to eligible professionals who did not meet meaningful use requirements.
The agency reviewed $6 billion in EHR incentive payments that CMS made to more than 250,000 eligible providers from May 2011 through June 2014. As a result, the OIG published a report on June 12, "Medicare Paid Hundreds of Millions in Electronic Health Record Incentive Payments That Did not Comply with Federal Requirements."
Health Data Management reports that auditors also plan to review Medicare Part B payments for telehealth services, delivered via an interactive telecommunications system, covered by CMS, as long as certain requirements are met.
The Government Accountability Office also said that improper incentive payments were the primary risk to the EHR incentive program because of difficulties CMS has in overseeing the program and the reliance on providers to make self-attestations for the payments.
"Previous OIG reviews of Medicaid EHR incentive payments found that state agencies overpaid hospitals by $66.7 million and would in the future overpay these hospitals an additional $13.2 million," the OIG said in a statement. "These overpayments resulted from inaccuracies in the hospitals' calculations of total incentive payments."
In addition, "To support rural access to care, Medicare pays for telehealth services provided through live, interactive videoconferencing between a beneficiary located at a rural originating site and a practitioner located at a distant site. An eligible originating site must be the practitioner’s office or a specified medical facility, not a beneficiary’s home or office. We will review Medicare claims paid for telehealth services provided at distant sites that do not have corresponding claims from originating sites to determine whether those services met Medicare requirements."
According to the Health Law Insights blog, each provider is at risk for review or audit of their EHR use to ensure only proper payments were made: "Providers who have received an incentive payment or plan to make self-attestations about their use of an EHR should carefully review their eligibility for the incentive payment and maintain adequate support for their certifications of meaningful use."
In the event a provider discovers an improper incentive payment, there are voluntary refund avenues available to lower enforcement risk associated with these overpayments from CMS.
In addition to this, two U.S. Senators recently issued a letter to CMS Administrator Seema Verma requesting that the federal agency recover the $729 million in overpaid EHR incentive payments. Sens. Orrin Hatch (R-Utah) and Charles Grassley (R-Iowa) co-authored the letter as Chairman of the Committee on Finance and Chairman of the Committee on the Judiciary, respectively.
