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Medicare Inappropriately Paid Hundreds of Millions to Health Providers

The U.S. Centers for Medicare & Medicaid Services (CMS) faces obstacles that leave the Electronic Health Record Incentive Program (EHR) vulnerable to abuse and misuse.

The U.S. Department of Health and Human Services, Office of Inspector General, has identified improper incentive payments totaling more than $720 million to eligible health professionals.

On June 12, the Office of Inspector General issued a public report that found that CMS did not always make appropriate EHR payments to health professionals, like physicians, dentists, podiatrists, optometrists, and chiropractors.

medicare inappropriately paid hundreds of millions

Medicare Electronic Health Record Incentive Program Vulnerable to Abuse and Misuse

As an incentive for using certified electronic health record technology, the Federal Government has been making payments to eligible professionals and hospitals that attest to the “meaningful use” of the electronic record technology. As of June 2014, Medicare had made payments to health professionals and hospitals totaling more than $6 billion.

The Office of Inspector General recently conducted an audit of the Electronic Health Records Incentive Program payments made by Medicare from May 2011 to June 2014 — totaling more than $ $6,093,924,710.

A finding from this audit estimates that Medicare inappropriately paid $729,424,395 in incentive payments to eligible professionals and hospitals who did not meet Federal meaningful use requirements.

An excerpt from this recent report reads as follows:

“From May 2011 through June 2014, the Centers for Medicare & Medicaid Services paid an estimated $729 million in Medicare electronic health record incentive payments to eligible professionals who did not comply with Federal requirements. In addition, it paid $2.3 million in inappropriate electronic health record incentive payments to eligible professionals who switched incentive programs.”

Deceased Health Professionals Still Received Payments  

Medicare makes incentive payments to eligible health professionals legally authorized to practice medicine and have an active National Provider Identification (NPI) number.

According to Federal regulations, a NPI number is to be deactivated “upon receipt of appropriate information confirming the dissolution of a health care provider that is an organization, the death of a health care provider who is an individual, or other circumstances justifying deactivation.”

Upon the death of a health profession, the NPI number should be deactivated within 60 days.  Without a NPI number, a health provider is ineligible for Medicare Electronic Health Record program.

However, Medicare did not have the proper controls in place to recognize status changes, which allowed an inappropriate incentive payment to a deceased health provider. Additional, the audit found that 11 deceased health providers were still active in the payment system — even though they were deceased for more than 60 days.

Additional oversights made by Medicare concerning the EHR program incentive payments are detailed in the Inspector General’s report. The Office of Inspector General report also provides recommendations to help eliminate abuse and misuse of federal funds pertaining to this program.

The mission of the Office of Inspector General is to protect the Department of Health and Human Services (HHS) programs.  In addition, the agency’s duty is to protect the health and welfare of beneficiaries served by HHS programs.

The complete report titled, “Medicare Paid Hundreds of Millions in Electronic Health Record Incentive Payments that Did Not Comply With Federal Requirements,” is available to the public at the Office of Inspector General’s website located at: https://oig.hhs.gov/


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