Do EHRs Cause or Cure Fraud?

Electronic health records should help facilitate more accurate billing but, when misused, may actually promote fraud. However, depending on your perspective, EHRs are either the cause or the cure for fraudulent activity.

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Comments (4)
(Two attempts to post comments)
Posted by RD G | Monday, June 09 2014 at 8:33PM ET
Thank you for the summary Mr. Slabodkin.

I very much hope to see a follow on report looking a bit deeper into the subject matter. For example, I notice that you quote, without critique, forward-looking statements regarding future EHR functions that may assist in fraud detection or prevention. In this context, an important missing story element is that there is no reason why those functions could not have been implemented beginning 7 years ago. I choose that time because the Department of Health and Human Services had their own reports from 2005 and 2007 which conveyed that EHRs would initially increase fraud (2005 report to OIG) and that this could be mitigated or prevented (2007 report to OIG). The recommendations cited existing Standards/Best Practices, considered basic Records Management requirements in other industries. The OIG survey that your article mentions, which found that few hospitals had implemented recommended data quality (anti-fraud)functions, took their survey items from the 2007 report to the OIG.

(continued)
Posted by RD G | Monday, June 09 2014 at 9:48PM ET
(continued from prior comment)

It isn't as if there haven't been national alerts on EHR-mediated fraud for a long time. One of the problematic functions mentioned in the article is "cloning". The first guidances warning about cloning occurred at least 15 years ago in, for example, Cigna Government Services.―Medical Record Cloning Documentation Reminder.‖ Medicare Bulletin, Part B. March/April 1999. Machine-assisted analysis for problematic use of other types of copy functions can be found dating back to 2003 in such articles as Hammond, Kenric, et al. ―Are Electronic Medical Records Trustworthy?.

In short, it is both useful and important to ask why it has taken until 2014 to officially recognize the threat that unregulated EHRs represent to public and private health care financing. Currently there is no regulation of EHRs, nor are their tests for basic Records Management fitness for use as patient records (nor for patient safety). Currently EHRs are only "certified" against minimalist Records Management criteria in bench tests and not in actual use.

(continued)
Posted by RD G | Monday, June 09 2014 at 9:50PM ET
(continued)

Another future article might examine a more interesting question; why did the most recent "certification" regime ("Meaningful Use) eliminate, instead of leverage, the prior "certification" regime (CCHIT) that at least had achieved some minimum milestones for supporting Records Management, including minimalist data quality/anti-fraud.

I very much hope to read in Health Data Management these more interesting and perhaps provocative stories of how the Department of Health and Human Services decided to address EHR-mediated fraud in 2014, nine full years after they were forewarned of it and seven full years after they received a report how to mitigate or prevent it.

Finally, another untold story could be told of those in CMS and in the OIG who, despite various forces, pressed forward to make it impossible to ignore this threat to HHS statutory obligations, including the protection of the Medicare Trust Fund.

So, the answer to your headliner question, "Do EHRs Cause or Cure Fraud" is "Yes" and "Yes". EHRs exist that were designed to include functions that have no apparent legitimate use (authorship falsification and audits that can be disabled). EHRs, though, once they become adherent to basic Records Management requirements, will at least be capable of helping to mitigate fraud, when designed, implemented, trained, and supported for proper conscientious use by attentive and honest people.

Standards exist to support this, as does Compliance-oriented policies, procedures, and support. They simply await use and an Administration that is willing to require them. Those who have been laboring to assure trustworthy electronic records systems have seen multiple Administrations come and go, Republican and Democrat, and are still waiting for that day. Perhaps the several OIG reports in 2014 on EHR fraud, plus CMS operationalization of trusted HIT requirements, suggest the day is nigh.

(In re-reading this, I erred. The 2005 and 2007 reports were to the ONC, not the OIG. ONC is charged with facilitating universal EHR use, without requirements for fitness as records management systems.)

I look forward to your follow up articles on such topics.


Sincerely,
Reed D. Gelzer, MD, MPH
Trustworthy EHR
Co-Facilitator, HL7 Records Management and Evidentiary Support Workgroup
Chair, Prevention Workgroup to the 2007 Data Quality/Fraud Prevention report to the ONC
Posted by RD G | Monday, June 09 2014 at 9:57PM ET
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