Feds Crack Down On EHR Program Fraud
Recent cases show many hospitals committed fraud to be part of the EHR Incentive Program
The EHR Incentive Program is a way to provide cash incentives to qualifying providers which successfully attested to MU, however some providers have been caught taking advantage of the program. Gov Info Security writes, "Federal authorities are taking action to crack down on abuse of the HITECH Act electronic health record financial incentive program. They recently filed fraud charges against Joe White, former hospital chief financial officer in Texas, alleging that the hospital met the program's requirements." This lead to a whopping payment of $785,000. An HHS spokesperson stated that this was "one of the first cases" to arise from an OIG investigation of false HITECH ACT attestations.
According to the FBI, "Healthcare fraud costs the country an estimated $80 billion a year. And it's a rising threat, with national healthcare spending topping $2.7 trillion and expenses continuing to outpace inflation. Recent cases also show that medical professionals are more willing to risk patient harm in their schemes."
According to White's indictment, as explained in EHR Intelligence, "White faces two counts - false statement and aggravated identity theft - related to Shelby Hospital's attestation of its full-year demonstration of Stage 1 Meaningful Use for fiscal year 2012 following its initial 90-day reporting period in fiscal year 2011." Allegations against White are as follows:
- "White created a 2012 EHR attestation user ID and Social Security number of Shelby Regional's Director of Nursing and Assistant Administrator without that persons's knowledge around early October 2012.
- PB refused to submit the 2012 attestation for Shelby Regional when approached to do so by White on the grounds that the hospital in her view had not met the MU criteria.
- White was aware that Shelby Regional had not achieved MU and knew that the hospital only minimally used the EHR platform and continued to use paper records and charts as well as older, uncertified technology at the hospital."
Another fraud scheme, also reported by the FBI involved Tariq Mahmood, a Dallas County, TX physician. According to the report, Mahmood “was indicted by a federal grand jury on April 11, 2013, and charged with conspiracy to commit healthcare fraud and seven counts of health care fraud."
The report also explains that Mahmood "added, changed, deleted, and incorrectly sequenced diagnostic codes in a way that did not reflect the actual diagnoses and conditions of the patients. They submitted false and fraudulent claims to Medicare and Medicaid based on the added, changed, deleted, and incorrectly sequenced diagnostic codes. By means of fraudulent billing practices, the defendant and his co-conspirators are alleged to have unlawfully submitted false claims of more than $1.1 million and obtained $375,000."