Washington State made $11.3M in faulty Medicaid EHR incentive payments

The Washington State Health Care Authority made incorrect Medicaid electronic health record incentive payments to 19 hospitals, according to an audit by the Department of Health and Human Services Office of Inspector General.

The faulty payments totaled $11.3 million, including both overpayments and underpayments, resulting in a net overpayment of $9.2 million. Washington State did not always pay EHR incentive program payments in accordance with federal requirements, concludes the OIG.

“The State agency made incorrect hospital incentive payments because it did not review supporting documentation from the hospitals to help identify errors in its calculations,” found auditors.

The OIG report notes that the Government Accountability Office has identified improper payments as the primary risk to the EHR incentive programs.

“These programs may be at greater risk of improper payments than other programs because they are new and have complex requirements,” assert auditors.

Also See: N.J. made faulty Medicaid EHR incentive payments

Of the 20 hospital incentive payment calculations the OIG reviewed, 19 (95 percent) did not comply with Federal regulations or guidance or both. In addition, the report finds that some calculations had multiple deficiencies.

Among the recommendations that OIG made to Washington State in terms of corrective actions:

  • Refund to the federal government $9.2 million in net overpayments made to the 19 hospitals.
  • Adjust the 19 hospitals’ remaining incentive payments to account for the incorrect calculations, which will result in cost savings of nearly $2.5 million after December 31, 2015.
  • Review supporting documentation from all hospitals to help identify any errors in incentive payment calculations.

In written comments in response to the audit, Washington State partially agreed with the majority of OIG’s recommendations.

“The state agency concurred that unallowable costs should be refunded and any incentive payment should be adjusted to account for incorrect calculations, but it did not concur with the net overpayment and cost savings amounts,” according to OIG. Officials of the agency were not immediately available for comment on the settlement.

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