Obama admin: EHR fraud won't be tolerated

The U.S. Department of Health & Human Services and the Department of Justice have promised to come down hard on providers who misuse electronic health records to financially game the healthcare system.

HHS Secretary Kathleen Sebelius and U.S. Attorney General Eric Holder warned that law enforcement agencies are keeping an eye out for fraud and "will take action where warranted," in a letter sent Monday to five healthcare provider associations--the American Hospital Association, Association of Academic Health Centers, Association of American Medical Colleges, Federation of American Hospitals and National Association of Public Hospitals and Health Systems.

"We will not tolerate healthcare fraud," the letter said. "The President initiated in 2009 an unprecedented Cabinet-level effort to combat healthcare fraud and protect the Medicare trust fund, and we take those responsibilities very seriously."

Sebelius and Holder point to potential cloning of medical records as one of several indications that fraud could be on the rise. Medicare administrative contractor National Government Services earlier this month issued a notice, stating that cloned documents from EHRs mostly likely would result in payment denials.

The letter also mentions some hospitals may be using EHRs to upcode various procedures on patients, no doubt a reference to the Center for Public Integrity report unveiled last week.

"[W]e will continue to escalate our efforts to prevent fraud and pursue it aggressively when it has occurred," the letter explained.

In a response to Holder and Sebelius, AHA President and CEO Rich Umbdenstock fired back that more accurate documentation--a presumed result of EHR use--is not the same thing as fraud. He adds that the AHA is still waiting on the Centers for Medicare & Medicaid Services to adopt national evaluation and management guidelines to help clarify increasingly complex payment rules.

"What's needed is clearer guidance from CMS, not duplicative audits that divert much needed resources from patient care," Umbdenstock said. "No one questions the need for auditors to identify billing mistakes, but the flood of new auditing programs, such as Recovery Audit Contractors, MACs and others, is drowning hospitals with a deluge of redundant audits, unmanageable medical record requests and inappropriate payment denials."

To learn more:
- here's the Sebelius-Holder letter (.pdf)
- read Umbdenstock's response (.pdf)