EHR waste: States pay millions in incentives without verifying

A number of states could be paying millions of dollars in Medicaid incentives to ineligible hospitals and physicians' offices under Meaningful Use, a new report from the Department of Health and Human Services' Office of the Inspector General finds.

In its early review, the OIG found out that of 13 states that had approved Medicaid electronic health record (EHR) incentive program plans in place as of Jan. 14, 2011, 12 did not plan to verify all 11 of the eligibility requirements for EHR adoption incentive payments prior to the payments being made.

Only one state--Kentucky--said it would verify all 11 requirements prior to payment; Alabama and Alaska reported that they would verify 10 requirements. All of the states reviewed by the OIG--including Mississippi, North Carolina, Tennessee, Michigan, Texas, Oklahoma, South Carolina, Pennsylvania, Iowa and Wisconsin--indicated they would verify self-report eligibility information for at least half of eligibility requirements prior to payment.

No law currently is being broken, the OIG report emphasized. The Centers for Medicare and Medicaid Services (CMS) does not require states to verify self-reported eligibility information prior to payment, but "doing so helps states proactively ensure the integrity of their EHR incentive payments," the OIG said.

To receive payments, practitioners and hospitals must register for the Medicaid incentive program in their states by self-reporting information (e.g., patient volume, practitioner specialty) to show that they meet each of the eligibility requirements.

All 13 States did report that they will audit eligibility requirements after payment. The states, though, reported that they still are developing their specific plans: 11 said they plan to begin audits in this year, while one state plans to begin audits in 2012. A final state has not decided on its time frame.

For more information:
- here's the HHS OIG report (.pdf)
- view The Hill's Healthwatch article

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