On June 12, 2017, the Department of Health and Human Services Office of Inspector General (OIG) published a report with the objective of determining whether the Centers for Medicare & Medicaid Services (CMS) made proper incentive payments to providers for “meaningful use” of a certified electronic health record (EHR). The report, entitled “Medicare Paid Hundreds of Millions in Electronic Health Record Incentive Payments That Did not Comply with Federal Requirements,” estimates that CMS improperly paid $729 million in EHR incentive payments to providers who did not actually comply with the requirements of meaningful use.
The report makes several recommendations to CMS to address and recover the estimated $729 million in faulty payments by determining which providers did not actually meet the “meaningful use” criteria. CMS has already begun targeted risk-based audits in an effort to identify the inappropriate incentive payments.
In addition to this report, the Government Accountability Office stated that improper incentive payments were the primary risk to the EHR incentive program. This is in part due to difficulties CMS has in overseeing the program and the reliance on providers to make self-attestations for the payments.
As this report demonstrates, new focus is being placed on the EHR incentive program. 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. Federal regulations require documentation be kept for six years that supports the demonstration of meaningful use of EHRs required for the incentive payments. 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.