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OIG Reveals Plans to Scrutinize EHR Incentive Payments

In July 2017, the Department of Health and Human Services Office of Inspector General (OIG) revealed its plans to review the $14.6 billion in incentive payments the Centers of Medicare and Medicaid Services (CMS) made to hospitals between January 1, 2011 and December 31, 2016, pursuant to Medicare’s electronic health record (EHR) technology program. The OIG plans to review these payments in order to identify errors and inaccuracies which may have resulted in overpayments to hospitals

This announcement comes less than a month after the June report from the OIG, titled “Medicare Paid Hundreds of Millions in Electronic Health Record Incentive Payments That Did Not Comply with Federal Requirements (the “Report”) (an official OIG summary is available here). The Report was based upon a review of EHR Incentive Program payments made to 100 professionals, which found 14 improper payments in the amount of $291,222. Extrapolating these results, the OIG estimated a total of $729.4 million in improper payments to the over 250,000 EHR incentive eligible providers in the CMS system. According to the OIG, the $729 million figure is roughly 12% of the total payments made in connection with the EHR incentive program. A majority of the 14 improper payments discovered during the OIG’s review were based on providers failing to maintain accurate and detailed records—an issue which often arises with Medicare overpayments.

The OIG completed its report by making several recommendations to CMS:

  • Recover the $291,222 in actual overpayments discovered;
  • Review other incentive payments to attempt to identify and recover the remaining $729.4 million in estimated overpayments;
  • Review a random sample of provider’s documentation to identify inappropriate payments;
  • Educate providers on the documentation requirements for the program;
  • Recover the $2.3 million in overpayments due to providers switching between Medicare and Medicaid; and
  • Institute a program to assure payments are no longer received from both Medicaid and Medicare in the same year.

According to the OIG, CMS complied or “partially complied” with all the above recommendations.  The OIG expects results of its latest investigation to be publicly released sometime in the 2018 fiscal year.

For over 30 years, Wachler & Associates has represented healthcare providers and suppliers nationwide in a variety of health law matters, including the defense of Medicare overpayments. If you or your healthcare entity have any questions about the EHR incentive program, or any other health care regulatory compliance questions, please contact an experienced healthcare attorney at (248) 544-0888, or via email at wapc@wachler.com. You may also subscribe to our health law blog by adding your email at the top right of this page.