A report from the Department of Health and Human Services Office of the Inspector General (OIG) found that the Center for Medicare and Medicaid Services (CMS) had made Electronic Health Record (EHR) incentive payments to providers who did not meet Meaningful Use requirements for those payments. OIG estimated that $729,424,395 went out to those providers who should have been found ineligible. The Office also found that CMS had payed $2,344,680 to providers who had switched between Medicare and Medicaid incentive programs and who were not eligible for those payments.
To conduct the review of the incentive program, OIG looked at 100 eligible practitioners (EPs) of the 250,470 EPs to whom a total of $6,093,924,710 in incentive payments were made between May 2011 and June 2014. In that sample, 14 EPs were found to have received $291,222 in payments even though they had not met all requirements. The Office then extrapolated from this figure to estimate the total amount of ineligible dollars payed.
OIG made several recommendations to remedy the errors found by the report. The Office recommended the following:
- CMS recover the $291,222 payed ineligibly in the sample population as well as the $2,344,680 payed ineligibly to providers who had switched incentive programs.
- Review of all incentive payments over the years of the study to try and recover some of the $729,424,395 and a review of some self-attestations made after the audit period.
- CMS better educate EPs on proper documentation standards.
- Edits be employed to ensure that EPs receive payments under only one of the incentive programs and that, as CMS implements MACRA, it creates safeguards that verify that standards are met by providers.