The U.S. Office of Inspector General (OIG) has estimated that the U.S. Centers for Medicare and Medicaid Services (CMS) inappropriately paid $729.4 million in incentive payments to eligible professionals who did not meet the requirements of the meaningful use IT stimulus program.
The OIG estimated that 12% of the total payments made by CMS under the incentive program were inappropriate because the eligible professionals did not maintain support for their attestation to meaningful use of certified electronic health record (EHR) technology.
"Furthermore, CMS conducted minimal documentation reviews, leaving the self-attestations of the EHR program vulnerable to abuse and misuse" of federal funds, the OIG said in a statement.
In addition, CMS also made $2.3 million in EHR incentive payments that were not in accordance with program-year payment requirements when eligible professionals switched between Medicare and Medicaid incentive programs. CMS did not have edits in place to ensure that eligible professionals who switched from one program to the other were placed in the correct payment year upon switching, the OIG said.
As a result, the OIG recommended five actions for CMS:
- Recover $291,000 in payments made to the sampled eligible professionals who did not meet meaningful use requirements.
- Review eligible professional incentive payments to determine which eligible professionals did not meet meaningful use measures for each applicable program year to attempt recovery of the $279.4 million in estimated inappropriate incentive payments.
- Review a random sample of eligible professionals' documentation supporting their self-attestations to identify inappropriate incentive payments that may have been made after the audit period.
- Educate eligible professionals on proper documentation requirements.
- Employ edits within the National Level Repository system to ensure that an eligible professional does not receive payments under both EHR incentive programs for the same program year.
The OIG said that CMS concurred or partially concurred with all of its recommendations. The full report can be downloaded on the OIG's website.
