OIG Begins Assessment of Meaningful Use Fraud

Issues Survey to Hospitals Who Have Received EHR Incentive Payments

Established in 1976, the Health and Human Services (HHS) Office of the Inspector General (OIG) fights waste, fraud and abuse to over 300 HHS programs including Medicare, Medicaid, CDC, NIH, and FDA.

As part of the OIG’s investigation into Medicare and Medicaid fraud, on Monday this week the office sent  a letter to a number of hospitals who have received EHR incentive payments asking them to complete a survey identifying EHR fraud and abuse vulnerabilities. The hospitals receiving the survey have until Friday to complete it.

The survey is just one part of the overall OIG Work Plan for Fiscal Year 2013. The work plan includes Recovery Act Reviews for the EHR Incentive Programs found starting on page 117 of the Work Plan:

Medicare Part A and Part B:  Medicare—Incentive Payments for Electronic Health Records
We will review Medicare incentive payments to eligible health care professionals and hospitals for adopting electronic health records (EHR) and the Centers for Medicare & Medicaid Services (CMS) safeguards to prevent erroneous incentive payments. We will review Medicare incentive payment data from 2011 to identify payments to providers that should not have received incentive payments (e.g., those not meeting selected meaningful use criteria). We will also assess CMS’s plans to oversee incentive payments for the duration of the program and actions taken to remedy erroneous incentive payments.

Medicaid—Incentive Payments for Electronic Health Records
We will review Medicaid incentive payments to Medicaid providers and hospitals for adopting EHRs and CMS’s safeguards to prevent erroneous incentive payments. The Recovery Act establishes 100-percent Federal financial participation for allowable expenses for eligible Medicaid providers to purchase, implement, and operate certified EHR technology. (§ 4201.) The section also provides a 90-percent Federal match for State administrative expenses for the adoption of certified EHR technology by Medicaid providers. According to CBO estimates, Medicaid spending for incentives will total about $12 billion between 2011 and 2019. We will determine whether incentive payments to Medicaid providers to purchase, implement, and operate EHR technology were claimed in accordance with Medicaid requirements. We will also assess CMS’s actions to remedy erroneous incentive payments and its plans for securing the payments for the duration of the incentive program, as well as review payments to States for administrative expenses.

The OIG Work Plan will also look at security:

Health Information Technology System Enhancements
We will review HIT enhancements to CMS systems to ensure that they include standards adopted by the Department of Health and Human Services (HHS) and that adequate information technology (IT) security controls are in place to protect sensitive EHR and personal information.

Only hospitals that received Medicare incentive payments for meeting meaningful use between Jan. 1, 2011 and March 31, 2012 were asked to complete the survey.

You can also watch a 30 minute video OIG released today on the 2013 Work Plan.  In this video OIG senior executives discuss emerging trends in combating fraud, waste, and abuse in Federal health care programs. This includes the EHR Incentive Programs.