A new study by the Health and Human Services department's Inspector General has found shortcomings in the way the Centers for Medicare & Medicaid Services and the agency's contractors protect against fraud when examining electronic health records.

In particular, OIG studied how contractors assess if EHRs are being used to commit payment fraud. “CMS and its contractors had adopted few program integrity practices specific to EHRs,” the report states. “Specifically, few contractors were reviewing EHRs differently from paper medical records. In addition, not all contractors reported being able to determine whether a provider had copied language or over documented in a medical record. Finally, CMS had provided limited guidance to Medicare contractors on EHR fraud vulnerabilities.”

The authors recommended CMS provide guidance to its contractors on detecting fraud associated with EHRs. For example, they said CMS could work with contractors to identify best practices and develop guidance and tools for detecting fraud associated with EHRs. They also suggested CMS should direct its contractors to use providers’ audit logs.

“CMS concurred with our first recommendation and partially concurred with our second recommendation,” the authors wrote. For the full report, click here.

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