EHRs cause fraud? Not so fast, guys

Okay, I must confess, I'm getting a big kick out of the latest study on electronic health records and fraud, published this week in Health Affairs. 

It turns out that the providers may have been right all along: Simply using an EHR does not lead to fraudulent billing. 

The study reviewed 393 hospitals that had recently adopted EHRs and compared them to 782 control hospitals that hadn't. It found that there was "no empirical evidence to suggest that hospitals are systematically using EHRs to increase reimbursement."  This was true even for for-profit hospitals, those in the most competitive markets and those with a high proportion of Medicare patients, all hospitals with a greater incentive to upcode.

All of the hospitals studied had increased their Medicare billings, not just the EHR users. And in comparable amounts, "indistinguishable" from each other.  

The results fly in the face of the New York Times' 2012 article that warned that providers were overbilling Medicare in large part because were taking advantage of tools in their EHRs. The Health Affairs study authors suggest that the discrepancy between their study and the newspaper's is that the latter didn't use a control group of non-EHR users for comparison. In other words, the New York Times research may be flawed.

This study is very good news. It provides evidence that EHRs are not necessarily the fraud ogres they've been held out to be. 

Of course, there will be occasional providers who use their EHRs wrongfully to overbill. But providers that are going to try to defraud the government will find ways to do it whether they're using EHRs or paper records. And while some EHR tools, like copy-and-paste, can make it easier to bill incorrectly or improperly, providers can take steps to reduce that risk.

And in fact, an EHR's ability to capture billable codes that may have been otherwise missed can actually reduce improper billing by "right coding." Undercoding is just as much a false claim as is upcoding. But that never makes the news. 

The government has gone to great lengths to ferret out fraud, and rightly so. More than $80 billion in overpayments were still made last year despite fraud recoveries of $4.3 billion. The fraud should be prevented and detected; the fraudsters punished. Medicare fraud hurts not only Medicare, it hurts us, the taxpayers.

But the government may be better off focusing on sham providers, off-label marketing, kick back schemes and identity theft.  

The government has taken a highly publicized hard line stance against EHR fraud in reaction to the New York Times article and similar, anecdotal information. EHRs are a major focus of the OIG's work plan and strategic plan. The OIG also issued a report earlier this year chastising CMS for not addressing EHR vulnerabilities.

While this is understandable, the Health Affairs study suggests that this focus on EHR fraud may be "misplaced."

We really can't expect the government to suddenly shift gears away from potential EHR fraud. It has invested a lot in this, and indeed some EHR fraud does occur. So providers can't ignore the fact that this is very much on the government's radar and they need to take steps to ensure that they don't use their EHRs to bill incorrectly. 

But if the Health Affairs study is not a fluke--and there should be more studies to test that--then the government should revisit its stance and consider spending its resources elsewhere. - Marla (@MarlaHirsch and @FierceHealthIT)

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