OIG Finds Over $700 Million in Inappropriate Meaningful Use Payments

The Department of Health & Human Services, Office of Inspector General (OIG) issued its report on Electronic Health Record Incentive Payments, also known as “meaningful use” dollars, and found that the Centers for Medicaid & Medicare Services (CMS) inappropriately paid $729,424,395 to eligible professionals (EPs) who did not meet the program’s requirements. The program was enacted under the Health Information Technology for Economic and Clinical Health Act (HITECH Act) as a means to promote electronic health records (EHR) and improve health care quality, safety, and efficiency. It is estimated that over six billion dollars were paid to EPs under the program from May 2011 to June 2014.

The program requires EPs to attest that they meet program requirements by self-reporting data through CMS’s online system. EPs who qualify for both the Medicare and Medicaid programs must elect to receive payments only from one program and may receive payments for up to five years. The audit revealed EPs had insufficient attestation support, inappropriately reported periods, or insufficiently used certified EHR technology. In addition, CMS failed to ensure that EPs who switched programs were placed in the correct payment year. The errors occurred, in part, because CMS conducted minimal documentation reviews of self-attestations, “leaving the EHR program vulnerable to abuse and misuse of Federal funds.” The errors discovered totaled approximately $291,222 in inappropriate payments and $2,344,680 in over-payments.

Among its recommendations, the OIG called for “stronger program integrity safeguards” that allow for more consistent verification. The OIG also recommended that CMS recover the inappropriate payments and over-payments revealed by the audit and conduct additional reviews to recover the $729,424,395 in estimated inappropriate payments, as well as any inappropriate payments made after the audit period. CMS indicated it would continue to conduct targeted risk-based audits through 2017.