OIG: CMS' poor auditing leaves Meaningful Use program 'vulnerable'

The Centers for Medicare & Medicaid Services is falling down on the job when it comes to verifying if providers receiving incentive payments are entitled to them, according to a new report from U.S. Department of Health & Human Services' Office of Inspector General. 

The report blasts CMS for not verifying the accuracy of providers' attestation information both before and after paying the incentive, leaving the program "vulnerable."

"Currently, CMS has not implemented strong prepayment safeguards," the report states. "CMS does not verify the accuracy of professionals' and hospitals' self-reported information prior to payment because data necessary for verifications are not readily available. CMS also does not direct high-risk professionals and hospitals to submit supporting documentation for prepayment review."

OIG also found that ONC's requirements for EHR reports in certified EHR technology may be contributing to CMS' oversight obstacles, since those reports are not sufficient for CMS to verify providers' reports.

"Absent changes to the definition of Meaningful Use, CMS should consider ways to strengthen its program oversight to protect the $4 billion in Medicare EHR incentive payments that it has paid, as well as billions of dollars in future incentive payments," OIG said.

OIG recommended that CMS obtain and review supporting documentation prior to payment to verify the accuracy of self reported information and issue guidance with specific examples of documentation that providers should maintain to support the compliance.

The report mirrors a report earlier this year from the Government Accountability Office, which also expressed concern that CMS was not verifying provider attestation information before distributing payments to them.

To learn more:
- here's the OIG report (.pdf)
- read this New York Times article