Medicare Improperly Paid $729 Million in EHR Incentive Payments

July 13th, 2017

The Centers for Medicare & Medicaid Services (CMS) paid an estimated $729 million in erroneous incentive payments to providers for meeting electronic health record (EHR) meaningful use attestations, according to a new report from the Department of Health and Human Services Office of Inspector General (OIG).

CMS pays so-called “eligible professionals” (EPs) and hospitals incentive payments to adopt EHRs. These entities must attest to the meaningful use of the EHR to receive these incentive payments. As of June 2014, CMS has paid out more than $6 billion dollars in EHR incentives to EPs. The newly implemented Merit-based Incentive Payment System (MIPS) uses a different calculation for meaningful use incentive payments.

OIG used a relatively small sample of 100 EP attestations to estimate the accuracy of the self-reported meaningful use and subsequent payments. OIG found that 14 of the 100 samples did not meet the attestation requirements due to insufficient attestation report, inappropriate reported meaningful use periods, or inappropriate EHR technology. The payments to these 14 EPs totaled $291,222. Based on that sample, OIG estimated that approximately $729 million was improperly paid. In addition, it estimated more than $2 million was inappropriately paid to EPs that switched between the Medicare and Medicaid incentive programs. Inabilities to detect the switch led to overpayments to some EPs.

OIG officials chided CMS for inadequate oversight. “CMS's minimal oversight of self-attestations left the EHR program vulnerable to abuse and misuse of Federal funds,” according to the report.

OIG recommended that CMS recover the erroneous payments to the sampled EPs, review EP incentive payments to determine which EPs did not meet meaningful use measures for each applicable program year, review a random sample of EPs' documentation supporting their self-attestations, educate EPs on proper documentation requirements, recover $2.3 million in overpayments made to EPs that switched programs, and ensure that an EP does not receive payments under both EHR incentive programs for the same program year. The OIG also suggested that the MIPS formulation have stronger attestation criteria to avoid further losses.