EHR-enabled fraud remains a concern
While the Centers for Medicare and Medicaid Services (CMS) estimates that nearly $29 billion of improper payments were made in 2015, according to spokespersons for the Office of the Inspector General (OIG) and CMS, the full extent of EHR fraud remains elusive.
Imagine, in an effort to bill a higher fee, a colleague cuts and pastes a complete history and physical examination you wrote in the
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A little background
In December 2013, OIG published “Not All Recommended Fraud Safeguards Have Been Implemented in Hospital EHR Technology,” which addressed whether providers used the fraud prevention strategies recommended by the Office of the National Coordinator for Health Information Technology (ONC). Recommended fraud prevention strategies had been used only minimally. It subsequently recommended that audit logs be kept on when EHR technology is available for viewing, that ONC and CMS develop a comprehensive plan to address fraud vulnerabilities in EHRs and that CMS develop guidance on the use of the copy-paste feature.
CMS stated that it supports ONC’s development of certification criteria toward this goal, that it was committed to providing technical assistance to other federal agencies with healthcare fraud enforcement authority and that it audits hospitals to ensure the integrity of the EHR incentive payments. CMS said that it would develop guidelines to ensure that the copy-paste feature is used appropriately.
Further reading:
A January 2014 OIG report, “CMS and Its Contractors Adopted Few Program Integrity Practices to Address Vulnerabilities in EHRs,” stated that not all contractors reported being able to determine whether a provider had copied language or overdocumented in a medical record and that CMS had provided limited guidance to Medicare contractors on EHR fraud vulnerabilities.
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