Thursday, January 8, 2015

Health & Human Services Office of the Inspector General: EHRs Can Facilitate Medicare Fraud

EHR fraud police?
Disease Management Care Blog readers are well aware that it is a nattering nabob of electronic health record (EHR) negativity. It not only has the professional scars from past encounters with these on-screen scourges, the DMCB's literature reviews suggest the impact of the EHR on quality is questionable and its ability to reduce costs is illusory In fact, there's evidence that it can increase costs and hike hospitalization rates.

In addition, the DMCB has repeatedly raised the phenomena of copying and pasting and zombie diagnoses that lead to bloated and inaccurate EHR notes.

Well, readers and detractors no longer have to take just the DMCB's word for it. Things are so bad that even CMS should be worried.

According to this just-released report from the Department of Health and Human Services' (HHS) Office of the Inspector General (OIG), "copy-pasting" and "overdocumentation" are increasing the rates of Medicare fraud.

The former can pepper the EHR with inaccurate information that leads to unnecessary testing and treatment, while the latter makes the work of patient care appear more complicated than it really is.

What's more, the OIG points out that while HHS has been very active (and remuneratively generous) in promoting EHR "meaningful use," it has done little to respond to EHR-enabled fraud. Short of a live human personally comparing multiple notes simultaneously, CMS and its contractors have no ability to systematically audit patient billing records. What's more, there are no consistent internal policies in place or agreement on what to do even if it is detected (such as payment suspensions, overpayment adjustments or referrals to law enforcement).

The DMCB's take:

It remains to be seen if this warning will lead the HHS bureaucracy to catch up with another unintended consequence of health information technology.  If it does, the DMCB is worried that CMS may take its cue from the hostile RAC audits and further alienate physicians. 

Time will tell.

Image from Wikipedia

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