Prepayment review for Meaningful Use incentives is OK by me

What I found most striking about the Office of Inspector General's report last week lambasting the Centers for Medicare & Medicaid Services for inadequate auditing and oversight of the Meaningful Use incentive program was the disagreement about what CMS should be doing to verify whether providers are entitled to incentive payments before doling those payments out.

OIG determined that CMS did not verify the accuracy of self-reported attestation information, and has not been collecting supporting documentation to verify that information before payment. To that end, OIG recommended that CMS conduct more prepayment review, including the collection of supporting documentation from providers. This assessment echoes that of the Government Accountability Office, which also expressed concern about paying providers without first verifying that they have met the Meaningful Use requirements.

Not everyone agrees with this call for prepayment review, though. CMS certainly doesn't. It would not concur with OIG's recommendation, saying that prepayment reviews and documentation requirements would impose increased upfront burdens on providers that could delay payments.

Ashish Jha, M.D., professor at Harvard Medical School and School of Public Heath agreed with CMS, noting in a commentary published in the journal Health Affairs that  there is "no evidence" that providers are systematically committing fraud by attesting that they've met Meaningful Use when they haven't. He, too, said that prepayment review would impose a "huge new burden" that would dissuade providers from adopting EHRs.

While Jha raises some good points, the OIG recommendation doesn't impose prepayment review on every provider. It doesn't even impose it on many providers. OIG suggests that "selected high-risk professionals and hospitals" should submit supporting documentation for prepayment review. It doesn't identify how CMS should determine which providers are at high risk for not meeting the requirements, but presumably there would be some indicators, such as outlier measurements or providers already on record for billing improprieties, that could provide a clue.

Moreover, the OIG report never mentions the word "fraud." Here, OIG is just trying to ensure that only providers who are entitled to the incentive money actually receive it. And there is plenty of anecdotal evidence that providers have attested to meeting the Meaningful Use requirements when they know full well that they have, in fact, not met those requirements.

What's likely really going on here is that OIG is trying to align Medicare's programs, many of which are moving away from "pay and chase" to prepayment review. But these are not broad based programs, at least not yet. For instance, the Recovery Audit prepayment review program is a demonstration in just a few states with known fraudsters and error-prone providers.   

There's also pressure from Congress and elsewhere that the Meaningful Use program be administered prudently.  Post-payment audits just may not be sufficient. The OIG report itself notes that CMS hasn't even completed any such audits.

I agree that there should not be undue obstacles thrown around just to impede EHR adoption. But additional reasonable oversight? More safeguards to ensure that providers are actually entitled to my taxpayer money before receiving it? I don't see a problem with that. - Marla