The Centers for Medicare and Medicaid Services paid $729.4 million in improper incentive payments to eligible professionals who did not meet Meaningful Use requirements, according to a new audit by the Office of Inspector General of the Department of Health and Human Services.
OIG reviewed $6 billion in electronic health record incentive payments that CMS made to more than 250,000 EPs from May 2011 through June 2014. Auditors found that, on the basis of their sample results, the agency inappropriately paid 12 percent of the total in incentive payments to EPs who did not meet MU requirements.
“These errors occurred because sampled EPs did not maintain support for their attestations,” states the report. “Furthermore, CMS conducted minimal documentation reviews, leaving the self-attestations of the EHR program vulnerable to abuse and misuse of federal funds.”
Auditors selected a simple random sample of 100 EPs who received one or more payments during the audit period and reviewed support for their attestations to MU measures.
“On the basis of our sample of 100 EPs, we identified 14 EPs with payments totaling $291,222 that did not meet the Meaningful Use requirements because of insufficient attestation support, inappropriate reported Meaningful Use periods or insufficiently used certified EHR technology,” states the report. “On the basis of our sample results, we estimated that CMS inappropriately paid $729,424,395 in incentive payments to EPs who did not meet Meaningful Use requirements.”
In addition, auditors reviewed all payments made to deceased EPs and to EPs who switched between Medicare and Medicaid programs to determine whether inappropriate payments had been made during the 2011-2014 audit period.
OIG found that CMS made EHR incentive payments totaling $2.3 million that were not in accordance with the program-year payment requirements when EPs switched between Medicare and Medicaid incentive programs.
“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,” states the report.
Auditors recommended that CMS take six actions:
• Recover $291,222 in payments made to the sampled EPs who did not meet MU requirements.
• Review EP incentive payments to determine which EPs did not meet MU measures for each applicable program year to attempt recovery of the $729.4 million in estimated inappropriate incentive payments.
• Examine 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 $2.3 million in overpayments made to EPs after they switched programs.
• Use edits within the National Level Repository system to ensure that an EP does not receive payments under both EHR incentive programs for the same program year.
CMS officials were not immediately available for comment. However, in its written response to the OIG, the agency concurred with auditors’ first, fourth, fifth and sixth recommendations and provided information on actions that it had taken or planned to take to address those recommendations. CMS also partially concurred with OIG’s second and third recommendations, stating that it has implemented targeted risk-based audits to strengthen program integrity and will continue to do so in 2017.
Nonetheless, OIG said it continues to “recommend that CMS review EP incentive payments to determine which EPs did not meet meaningful use requirements and attempt recovery of the estimated $729.4 million, as well as review a random sample of EPs’ documentation supporting their self-attestations to identify inappropriate incentive payments.”
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