CMS Overpaid Providers $729 Million in Incentive Payments

June 16th, 2017 - Chris Woolstenhulme, CPC, CMRS
Categories:   Medicare   Practice Management   MIPS|PQRS|PQRI  
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Medicare paid hundreds of millions in electronic health record incentive payments that did not comply with federal requirements according to the OIG.  The OIG estimated CMS inappropriately paid $729,424,395 to EPs who did not meet the requirements for meaningful use.

Eligible professional’s (EP’s) are physicians, dentists, podiatrists, optometrists or chiropractors, if registered to participate in the EHR incentive program may receive incentive payments for up to 5 years.  Although an EP may be eligible to report through self reporting for both Medicare and Medicaid, they may not report and receive incentive payments from both programs, the EP must select only one program.

The office of inspector general reported in June 2017 during the period of May 2011 through June 2014 the Centers for Medicare & Medicaid Services paid an estimated $729 million in Medicare electronic health record incentive payments to eligible professionals who did not comply with Federal requirements.

In addition, CMS paid $2.3 million in inappropriate electronic health record incentive payments to eligible professionals who switched incentive programs. 12 should not have been awarded incentive payments as they could not provide support for the attested measures. The OIG stated, “Of the 100 EPs in the sample, 12 could not provide support for the measures to which they attested: six EPs could not provide a security risk assessment; four EPs could not provide support that they had generated at least one report listing patients with a specific condition, and three EPs; could not provide required documentation in the form of patient encounter data for the measures to which they self-attested”. This resulted in $253,622 in inappropriate incentive payments, according to OIG.

The OIG reveled due to the fact that the sampled EP’s did not maintain support for their attestations; it “left the EHR program vulnerable to abuse and misuse of Federal funds.” The findings in the OIG review identified 14 EP’s out of 100 that did not meet meaningful use requirements due to insufficient attestation support, inappropriate reported periods, or did not use certified EHR technology. The overpayment on just these 14 EPs totaled $291,222. 

The Office of inspector General recommended CMS recover the $729,424,395 in estimated inappropriate incentive payments and educate EP’s on proper documentation requirements.  It was also recommended CMS employ edits to ensure that an EP does not receive payments under both CMS and Medicaid programs in the same year.

The OIG also recommended with MACRA, any modifications with meaningful use requirements include stronger program integrity safeguards to ensure a more consistent verification to ensure EPs are using and reporting EHR technology consistent with CMS’s goal of Advancing Care Information under MIPS. 

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