Incorrectly Performed Meaningful Use Audits Hurt Small Practices

A recent report by the Office of the Inspector General (OIG) at the Department of Health and Human Services suggested that hundreds of millions of dollars in Meaningful Use (MU) incentive payments were paid incorrectly to eligible professionals (EPs), who did not qualify for these payments.[1] Based on a sample of 100 EPs, the Inspector General alleged to have found “insufficient attestation support, inappropriate reported meaningful use periods, or insufficiently used certified EHR technology” resulting in $729,424,395 in incentive payments to EPs, who were not eligible for payments.

Claiming to the dollar how much money was paid incorrectly in a $36 billion incentive program[2] to hundreds of thousands of EPs based on a sample of 100 EPs offers more precision than the methodology would permit demonstrating scientific weakness and may be a display of overconfidence in the audit and accounting prowess. However, based on our experiences outlined below, these claims are incorrect and damaging to the reputation of eligible providers and a risk to the financial viability of their practices. Significant money was expended by EPs to meet MU requirements, and additional resources are expended by them to respond to the audits.

MU was designed to incentivize EPs and eligible hospitals to adopt certified EHR technology. The intention of the HITECH Act was to move providers from paper to EHRs. Even though MU incentives pay only for a fraction of the cost of ownership of an EHR, physicians went along trusting the promise that at least a portion of their expenses would be offset by MU.[3] The efforts by Medicare and Medicaid to “claw back” incentive monies came at great surprise and shock to many EPs, especially years after the incentives were paid. It is important to remember that the MU program was implemented without any guidance for EPs regarding documentation requirements to support audits. All of the audit documentation requirements were written after the program had been implemented.[4]

The OIG audited CMS's payments based on the attestation data provided by EPs. As written, the OIG report could be misinterpreted as evidence that EPs tried to obtain inappropriate payments by defrauding CMS. Rather, the correct interpretation is that the CMS attestation and payment authorization system was inadequately designed and tested. CMS has conducted audits of EPs looking into appropriateness and accuracy of submitted attestation data. These audits also have serious issues that need to be addressed because they have been harming EPs.

Note

The views presented do not necessarily represent the official policy of the American Academy of Family Physicians, the American Academy of Pediatrics, or the American College of Physicians.

• References

• 1 Department of Health and Human Services. Office of Inspector General. Medicare paid hundreds of millions in Electronic Health Record incentive Payments that did not comply with Federal Regulations. Available at: https://oig.hhs.gov/oas/reports/region5/51400047.pdf . Accessed July 10, 2017
• 2 Centers for Medicare and Medicaid Services. Data and Program Reports. Available at: https://www.cms.gov/Regulations-and-Guidance/Legislation/EHRIncentivePrograms/DataAndReports.html . Accessed July 28, 2017
• 3 Koppel R, Lehmann CU. Implications of an emerging EHR monoculture for hospitals and healthcare systems. J Am Med Inform Assoc 2015; 22 (02) 465-471
• 4 CMS EHR Incentive Programs Supporting Documentation For Audits. Available at: https://www.cms.gov/Regulations-and-Guidance/Legislation/EHRIncentivePrograms/Downloads/EHR_SupportingDocumentation_Audits.pdf . Accessed January 3, 2018
• 5 CMS MLN Fact Sheet: Complying with Medical Record Documentation Requirements. Available at: https://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNProducts/Downloads/CERTMedRecDoc-FactSheet-ICN909160Text-Only.pdf . Accessed January 3, 2018