OIG wants proof before making meaningful use payments

The Office of Inspector General (OIG) is criticizing CMS’ oversight of the Meaningful Use incentive program. They worry that CMS might be paying organizations who do not qualify for Meaningful Use incentives.

This study is an early assessment of CMS’s oversight of the Medicare electronic health record (EHR) incentive program, for which CMS estimates it will pay $6.6 billion in incentive payments between 2011 and 2016. Because professionals and hospitals self report data to demonstrate that they meet program requirements, CMS’s efforts to verify these data will help ensure the integrity of Medicare EHR incentive payments.

OIG went on to say (emphasis added)

CMS faces obstacles to overseeing the Medicare EHR incentive program that leave the program vulnerable to paying incentives to professionals and hospitals that do not fully meet the meaningful use requirements. Currently, CMS has not implemented strong prepayment safeguards, and its ability to safeguard incentive payments postpayment is also limited. The Office of the National Coordinator for Health Information Technology (ONC) requirements for EHR reports may contribute to CMS’s oversight obstacles.

Here are their recommendations

We recommend that CMS: (1) obtain and review supporting documentation from selected professionals and hospitals prior to payment to verify the accuracy of their self-reported information and (2) issue guidance with specific examples of documentation that professionals and hospitals should maintain to support their compliance. CMS did not concur with our first recommendation, stating that repayment reviews would increase the burden on practitioners and hospitals and could delay incentive payments. We continue to recommend that CMS conduct prepayment reviews to improve program oversight. CMS concurred with our second recommendation.

Will these recommendations change the Meaningful Use program or self attestation? Probably not. But you can bet that more scrutiny and audits are in store for organizations claiming to have met the Meaningful Use objectives. As we have mentioned in the past, don’t forget to do the required risk assessment before you attest.