Electronic Health Records

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Meaningful use fraud: HHS, DoJ issue warning

By Kyle Murphy, PhD

- Falsely demonstrating meaningful use would not only defeat the purpose of using electronic health records (EHRs) to improve the care of American patients but also warrant investigations by federal law enforcement, according to the Attorney General of the Department of Justice (DoJ) and Secretary of the Department of Health & Human Services (HHS).

In a joint letter published by the New York Times, Eric Holder, Jr., and Kathleen Sebelius made several hospital associations aware of providers’ attempts to cheat their way into receiving incentive payments in EHR Incentive Programs. The American Hospital Association, Association of Academic Health Centers, National Association of Public Hospitals and Health, Federation of American, and Association of American Medical Colleges are all listed as addressees of the letter.

Despite the increased adoption of EHR systems by hospitals and successful attestation of more than half of hospitals participating in the Centers for Medicare & Medicaid Services (CMS) meaningful use initiative, the federal government has also noticed an unwelcomed trend. “However, there are troubling indications that some providers are using this technology to game the system, possibly to obtain payments to which they are not entitled. False documentation of care is not just bad patient care; it’s illegal,” noted Holder and Sebelius.

According to the Attorney General and Secretary, early reports have indicated two practices that violators of meaningful use are using to game the system. One refers to the process of cutting and pasting the same information across records, and the other deals with misrepresenting a patient’s condition:

These indications include potential “cloning” of medical records in order to inflate what providers get paid. There are also reports that some hospitals may be using electronic health records to facilitate “upcoding” of the intensity of care or severity of patients’ condition as a means to profit with no commensurate improvement in the quality of care.

The end result is the cheapening of a patient’s individualized care, which fundamentally threatens both the legitimacy of meaningful use as well as the ethical foundation of medicine. “This letter underscores our resolve to ensure payment accuracy and to prevent and prosecute health care fraud,” continued Holder and Sebelius, “A patient’s care information must be verified individually to ensure accuracy: it cannot be cut and pasted from a different record of the patient, which risks medical errors as well as overpayments.”

Both the DoJ and HHS have put providers on notice that these types of worst practices constitute fraud. “Law enforcement will take appropriate steps to pursue health care providers who misuse electronic health records to bill for services never provided,” explained the DoJ and HHS heads. Moreover, the Affordable Care Act has empowered CMS to detect fraud and withhold Medicare payments for suspicious claims, leading to a 75% increase in prosecutions in 2011 as compared to 2008.

Waste is already a major challenge facing American healthcare. According to the Institute of Medicine’s latest findings, the healthcare industry doled out an estimated $750 billion in unnecessary expenditures in 2009. Health information technology (IT) (e.g., EHR systems) is supposed to minimize these losses. With many critics already debating whether EHR systems can lead to lower healthcare costs and better care, the revelation that providers are cheating the system does little to inspire confidence in meaningful use.

Read the complete New York Times article. View the DoJ/HHS letter.

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