OIG: CMS made $729.4M in erroneous EHR incentive payments

Medicare made approximately $729.4 million in EHR incentive payments to hospitals, physicians and other health professionals who did not comply with federal requirements, according to a report by HHS' Office of Inspector General.

CMS offers incentive payments to healthcare providers and hospitals that demonstrate meaningful use of certified EHR technology. According to the OIG's audit, CMS made about $729.4 million in improper EHR incentive payments to providers and hospitals during the audit period of May 2011 to June 2014.

On the basis of its sample of 100 eligible professionals, the OIG identified 14 with payments totaling $291,222 that did not meet the requirements for incentive payments because they did not meet bonus criteria or failed to provide required proof of meeting the criteria.

Extrapolating from the sample results, the OIG estimated CMS inappropriately paid $729.4 million in incentives to hospitals and physicians.

Based on its findings, the OIG recommended CMS attempt to recover the estimated overpayments. The OIG also recommended CMS educate eligible professionals on proper documentation requirements and make changes to the National Level Repository, a provider registration and verification system that contains information on providers participating in the Medicare and Medicaid EHR incentive programs.

In written comments in February, then-acting CMS Administrator Patrick Conway said the agency had taken steps to address the OIG's recommendations. He said CMS has implemented risk-based audits "to strengthen program integrity," which will continue this year.

However, the OIG said the risk-based audits are not enough.

"After reviewing CMS' comments and having followup discussions with CMS officials, we maintain that the targeted risk-based audits are not capturing errors such as those identified in this report," wrote the OIG in its audit report. "We therefore continue to recommend that CMS review EP incentive payments to determine which EPs did not meet meaningful use requirements 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."

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