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US health, justice officials target EHR fraud in letter to health CEOs
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On Sept. 24, Attorney General Eric H. Holder Jr. and Secretary of the Department of Health and Human Services Kathleen Sebelius issued a joint letter on behalf of their respective agencies to the chief executive officers of five hospital trade associations about the adoption of electronic health record systems.
The purpose of the letter was to communicate indications and reports received by the Department of Justice (DOJ) and CMS that providers may be using EHR technology to “game the system” by upcoding the intensity of care or severity of patients’ conditions.
In the letter, Sebelius and Holder discussed two trends with respect to the increased adoption and meaningful use of EHR technology. First, they acknowledged that a high percentage of providers have adopted EHR technology and qualified for incentive payments from CMS that encourage the adoption of and meaningful use of this technology. Second, they stated that they have observed troubling indications that some providers are inappropriately using EHR systems to receive payment for services that were not rendered and inflate charges.
Adil Daudi
To support these indications, Sebelius and Holder cite new data-mining and auditing tools that have assisted regulatory authorities in monitoring and recovering payments. This had led to record-high collections and prosecutions in 2011 (according to the letter, prosecutions in 2011 were 75% greater than in 2008).
The letter presents an opportunity for providers to review education granted to users of EHR systems about appropriately using the tools that, while creating efficiencies, also may lead to practices identified by CMS and DOJ as a misuse of EHR technology.