News Feature | February 5, 2014

CMS Taken To Task By OIG For EHR Fraud Failings

By Christine Kern

HITO Fraud

OIG report underscores CMS deficiencies in preventing EHR fraud, failures costing healthcare as much $250 billion each year

By Christine Kern, contributing writer

Electronic health records may be the future of medicine, but they have also simplified the practice of fraud, according to the findings of a new report from the Office of Inspector General. As Healthcare IT News reports, the OIG report underscored the shortcomings of the Centers for Medicare and Medicaid Services when it came to identifying and investigating EHR fraud - deficiencies which have helped contribute to the estimated $75 billion to $250 billion in healthcare fraud, officials say.

According to the report, there are two common documentation practices used to commit fraud: copy and paste, by which a healthcare provider copies and pastes information from a patient's record multiple times, often failing to update the data or ensure accuracy; and over-documentation, which involves adding false or "irrelevant documentation to create the appearance of support for billing higher level services."

The OIG report concluded that the CMS guidance for identifying fraud was too limited, and that most of the contractors reviewed paper records and EHRS In the same manner, with little attention to the differences between them. The findings showed that only 3 of 18 Medicare contractors used EHR audit log data as part of the review process. Further, contractors found it impossible to tell when cut and paste or over documentation had been used in EHR data.

HHS Inspector General Daniel Levinson recommended CMS direct contractors to use audit logs for investigations and also provide additional guidance on detecting fraud in EHRs. He stated, "Our findings show that CMS and its contractors have not changed their program integrity strategies in light of EHR adoption.” In response, CMS Administrator Marilyn Tavenner agreed that the agency needed to strengthen its efforts at preventing EHR fraud by recognizing the specific challenges of the record keeping.

According to an AHIMA Report, 74 to 90 percent of physicians use the copy/paste function in their EHRs, and between 20 and 78 percent of physician notes are copied texts.

Attorney General Eric Holder and HHS Secretary Kathleen Sibelius recently addressed industry medical groups in a letter, underscoring the seriousness of doctors "gaming the system." They pointed to reports of hospitals using EHRs to "upcode" patients' medical conditions, abuses which have been estimated to cost nearly $11 billion, according to a year-old report from the Center for Public Integrity.

Several U.S. Senators released a statement calling the findings "deeply concerning.” Tom Coburn (R-OK) issued a statement saying, in part, "CMS has a fundamental responsibility to do a better job of policing and enforcing basic security requirements.” Senator Lamar Alexander (R-TN) concurred, saying, "The Centers for Medicare and Medicaid Services should be doing everything it can to prevent and stop the fraud and abuse that undermine this crucial innovation in the health care industry and put Medicare at risk of overpaying for care.”

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