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Medicare Paid Hundreds of Millions in Electronic Health Record Incentive Payments That Did Not Comply With Federal Requirements

The Health Information Technology for Economic and Clinical Health Act established the Medicare and Medicaid electronic health record (EHR) incentive programs to promote the adoption of EHRs and to improve health care quality, safety, and efficiency through the promotion of health information technology and electronic health information exchange. As an incentive for using certified EHR technology, the Federal Government is making payments to eligible professionals (EPs) and hospitals that attest to the "meaningful use" of EHRs. To receive an incentive payment, EPs attest that they meet program requirements by self-reporting data through the Centers for Medicare & Medicaid Services' (CMS) online system.

CMS did not always make EHR incentive payments to EPs in accordance with Federal requirements. On the basis of our sample results, we estimated that CMS inappropriately paid $729.4 million (12 percent of the total) in incentive payments to EPs who did not meet meaningful use requirements. These errors occurred because sampled EPs did not maintain support for their attestations. Furthermore, CMS conducted minimal documentation reviews, leaving the self-attestations of the EHR program vulnerable to abuse and misuse of Federal funds.

CMS also 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.

We recommended that CMS (1) recover $291,000 in payments made to the sampled EPs who did not meet meaningful use requirements, (2) review EP incentive payments to determine which EPs did not meet meaningful use measures for each applicable program year to attempt recovery of the $729.4 million in estimated inappropriate incentive payments, (3) review a random sample of EPs' documentation supporting their self-attestations to identify inappropriate incentive payments that may have been made after the audit period, (4) educate EPs on proper documentation requirements, (5) recover $2.3 million in overpayments made to EPs after they switched programs, and (6) employ 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 concurred or partially concurred with all of our recommendations.

Filed under: Centers for Medicare and Medicaid Services