Use of electronic fraud auditing system growing rapidly

Nearly one-half million medical records have been submitted to Medicare auditors through the Electronic Submission of Medical Documentation (esMD) system since it launched in 2011.

In its annual report, The Centers for Medicare & Medicaid Services (CMS) notes rapid growth for the online portal, which was designed to streamline fraud review. The electronic submissions system saves providers from having to mail or fax in reams of reports.

More than 30,000 Medicare providers were using the system as Sept. 30, 2013, something those using EHR systems in particular had been requesting. Use of the system nearly tripled in 2013, according to CMS.

Last year it added a prior authorization capability for mobile devices in seven states and extended coverage to suppliers of durable medical equipment. It plans to expand the system's capabilities to include the ability to submit first-level appeals requests and discussion requests online.  It accepts only unstructured PDF documents, but there are plans to enable submission of structured electronic clinical data.

The Office of Inspector General's (OIG) updated strategic plan makes fighting fraud, waste and abuse one of its priorities for the new year.

EHR systems that allow autopopulation to automatically check what the clinician did to make the diagnosis and uncheck what he or she didn't do are creating a new potential for fraud, Jennifer Trussell, special advisor with the Office of Investigations at the Office of Inspector General, told an audience at the National Health Care Anti-Fraud Association (NHCAA)'s Annual Training Conference in Orlando, Fla.

And some software doesn't include audit trails. "So you don't know whether the doctor checked or unchecked, whether it was the biller, the receptionist or some guy on the street," she said.

The OIG's office also has urged healthcare organizations to limit the copy-paste function in EHRs to reduce the risk of fraud.

To learn more:
- find the report (.pdf)


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