Audit estimates CMS issued hundreds of millions of dollars' worth of incorrect EHR incentive payments

As part of a program to encourage providers to shift to EHRs, the federal government incorrectly paid hundreds of millions of dollars in incentive payments to healthcare professionals who did not actually meet Meaningful Use requirements.

The Department of Health and Human Services Office of Inspector General estimates that inappropriate payments to eligible professionals totaled $729 million between May 2011 and June 2014, according to a newly released audit (PDF).

To be eligible to receive an incentive payment from either the Medicare or Medicaid programs, eligible professionals—which can include physicians, dentists, podiatrists, optometrists or chiropractors—must self-report data attesting to their use of EHRs through the Centers for Medicare & Medicaid Services’ online system.

However, the OIG’s audit revealed that 14 eligible professionals out of a sample of 100 received payments totaling $291,222 that didn’t meet Meaningful Use requirements. Issues included "insufficient attestation support, inappropriate reported Meaningful Use periods or insufficiently used certified EHR technology.” Extrapolating those results, the agency reached its estimate of $729 million in erroneous payments.

In addition, the OIG said CMS did not ensure that eligible professionals who switched between the Medicare and Medicaid incentive programs were placed in the correct payment year upon switching. Thus, the audit identified 471 EHR incentive payments totaling $2.3 million that CMS made to eligible professionals for the wrong payment year.

The OIG recommended that CMS try to recover the payments made to eligible professionals who did not meet program requirements, as well as tighten its auditing processes and educate providers on proper documentation requirements.

The watchdog agency’s findings come on the heels of news that software company eClinicalWorks paid $155 million to resolve allegations from the Justice Department that it falsely certified its EHR software. And though the Massachusetts-based company is one of the more egregious offenders, it is hardly the only one to shirk EHR certification requirements, experts told FierceHealthcare.