OIG: CMS should try to recover $729M in erroneously paid EHR incentives

Out of the $6 billion CMS made in Medicare electronic health records (EHR) incentive payments by June 2014, the HHS Office of the Inspector General (OIG) estimated $729 million was paid to professionals who didn’t meet meaningful use requirements.

To receive the EHR incentive, eligible professionals (EPs) had to self-report data attesting they meet program requirements on use of certified EHRs. According to the OIG audit, however, many either provided insufficient attestation support, reported meaningful use periods inappropriately or weren’t used certified EHR technology to the extent required by the program.

“These errors occurred because sampled EPs did not maintain support for their attestations,” the OIG report said. “Furthermore, CMS conducted minimal documentation reviews of self-attestations, leaving the EHR program vulnerable to abuse and misuse of federal funds.”

In the sample of 100 EPs audited by OIG, it identified 14 who were paid more than $291,000 without meeting the program’s requirements. Extrapolating those sample results is how the agency came to the $729 million figure.

The audit also identified payments totaling $2.3 million CMS made in the wrong payment year. This was caused by EPs switching between the Medicare and Medicaid incentive programs, and the report blamed CMS for not having “the edits in place to ensure that EPs who switched from one program to the other were placed in the correct payment year upon switching.”

The report recommended CMS recover the $291,000 in incorrect payments identified in the sample audit, a suggestion on which CMS agreed. It also said CMS should conduct a much greater review for recovering the potential $729 million in inappropriate payments. On this recommendation, the agency only partially concurred, with then-acting CMS Administrator Patrick Conway saying in March it had implemented targeted risk-based audits “to strengthen the program integrity.”

That isn’t a sufficient response, the OIG argued, saying the targeted audits won’t capture the errors it identified.

“We therefore continue to recommend that CMS review EP incentive payments to determine which EPs did not meet meaningful use and attempt recovery of the estimated $729,424,395, as well as review a random sample of EPs’ documentation supporting their self-attestations to identify inappropriate incentive payments,” the report said.