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Senate Requests Return of $729.4M in Overpaid EHR Incentives

The Senate requested CMS recover $729.4 million in inappropriate EHR incentive payments based on recent OIG findings.

EHR Incentive Payments

Source: Thinkstock

By Kate Monica

- Members of the Senate recently issued a letter to CMS Administrator Seema Verma requesting that the federal agency recover approximately $729.4 million in overpaid EHR incentive payments.

Senator Orrin Hatch (R-UT) and Senator Charles Grassley (R-IA) co-authored the letter as Chairman of the Committee on Finance and Chairman of the Committee on the Judiciary, respectively.

The large sum of inappropriate payments was totaled by the Office of Inspector General (OIG) in its report last month investigating whether CMS was sufficiently overseeing the Medicare EHR Incentive Program and making EHR incentive payments according to federal requirements.

In its report, OIG determined the following: 

  • Out of the 100 EPs sampled for this report, the OIG identified 14 EPs with payments totaling $291,222 who had not demonstrated meaningful use through sufficient attestation support, appropriate repo1ted meaningful use periods, or sufficient use of certified EHR technology.
  • On the basis of the OIG's sample results, they calculated that from May 2011 through June 2014 CMS paid over $729,424,395 in inappropriate EHR incentive payments.
  • The OIG also repo1ted that CMS made inappropriate EHR incentive payments to EPs who switched between the Medicare and Medicaid programs. As a result, the OIG calculated that CMS paid over $2,344,680 to 471 EPs for the wrong payment year.

As a result of its investigation, OIG provided CMS with six recommendations to resolve the listed issues. CMS concurred with four of these recommendations but only partially concurred with two of them.

“Most notably, CMS did not commit to recover the estimated $729,424,395 in inappropriate payments,” wrote undersigned Senators.

CMS stated it has implemented targeted risk-based audits to strengthen the integrity of the EHR incentive program and will continue to improve its processes throughout 2017. To the contrary, OIG stated these audits are insufficient in tracking and mitigating the kinds of errors outlined in its report.

The Senate requested CMS address whether recovering the money lost through these payments is possible.

Additionally, Congress seeks answers to the following questions regarding the status of these erroneous funds to eligible providers (EPs): 

  • Please provide an update on how much of the $291,222 made to the 14 EPs sampled for the OIG’s report have been recovered
  • Given the estimated $729,424,395 in inappropriate incentive payments, why has CMS not made greater attempts to recover these funds?
  • Has CMS attempted to review a random sample of EP’s self-attestation documentation to identify inappropriate payments that may have been made after the audit period?
  • Provide an update on how much of the $2,344,689 in overpayments made to EPs who switched between Medicare and Medicaid have been recovered
  • Describe how targeted risk-based audits will work to recover inappropriate payments already made and prevent inappropriate payments made in the future, including in the context of the Medicare Merit-based Incentive Payment System that pertains to EPs beginning in 2017.  

Senator Hatch and Senator Grassley requested CMS provide a response to the letter by July 31, 2017.

While CMS did not concur with OIG’s recommendation to recover all $729.4 in inappropriate payments, the federal agency did agree to educate EPs on proper documentation requirements and recover certain payments deemed inappropriate in the report.

Additionally, CMS concurred with OIG’s recommendation to employ edits within the National Level Repository (NRL) system to ensure EPs who switch programs during a payment year receive payment in only one EHR incentive program to mitigate similar problems with overpayments in the future.

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