Fears about providers taking advantage of EHR technology to commit Medicare fraud may be unfounded, according to a study published online this week in Health Affairs. Concerns over intentional and inadvertent fraud, committed by copying and pasting inaccurate documentation or selecting incorrect billing codes, are not widespread enough to commit significant resources towards policy changes, found Julia Adler-Milstein, University of Michigan assistant professor of information, and Ashish K. Jha, Harvard professor of public health.
“There have been a lot of anecdotes and individual cases of hospitals using electronic health records in fraudulent ways. Therefore there was an assumption that this was happening systematically, but we find that it isn’t,” said Adler-Milstein.
The Office of the Inspector General (OIG) has criticized CMS for its lack of attention to the possibility of EHR-related fraud, although it has also admitted that the scope of such activities is currently unknown. In 2012, providers were issued a warning from the Department of Justice cautioning them against using EHRs to falsely attest to meaningful use, citing two practices that may have used upcoded medical records or cloned documentation to cheat their way into a successful attestation. Providers have since been required to endure audits to ensure proper compliance with the program’s rules.
Adler-Milstein and Jha found that there was little difference in the Medicare billing rate between hospitals that had adopted EHRs and those that hadn’t. Billing rates remained constant even for hospitals with a financial incentive to bump up their Medicare billings, such as those that operate on a for-profit basis, those experiencing fierce competition within their market, and facilities with a high proportion of Medicare patients.
While Medicare fraud in general is of critical concern for CMS, the Office of the Inspector General, and the Government Accountability Office, the majority of notable fraud schemes involve billing for false services uses fake patients, inflated diagnoses, or unlicensed practitioners, a racket that has long been conducted before EHRs became commonplace. In 2010, at the very beginning of the EHR Incentive Programs, Medicare paid out $6.7 billion in inappropriate evaluation and management (E/M) reimbursements due to poor documentation and coding efforts on the part of healthcare providers. At the time, only 57% of providers who billed for E/M services were using an EHR.