OIG Finds Fault with CMS Meaningful Use Oversight
In a report released on November 29, the Office of Inspector General (OIG) chastised CMS for not doing a better job of pre and post-payment oversight for the Medicare and Medicaid EHR Incentive Programs (Meaningful Use). As of September 2012, OIG stated that CMS has paid out approximately $4 billion to eligible professionals (EPs) and hospitals.
In the report, OIG looked at CMS’s oversight of Meaningful Use, examining self-reported data, CMS auditing planning documentation, guidance, and regulations, as well as conducted interviews with CMS key staff. It found that CMS failed to implement strong prepayment safeguards, and that postpayment safeguards were also limited, criticizing CMS for its reliance on self-reported data and failure to confirm its accuracy.
“CMS determines that professionals and hospitals are meaningful users of certified EHR technology, and therefore qualify for incentive payments, based solely on self-reported information. CMS does not verify that self-reported information is accurate prior to payment. Although CMS is not required to verify the accuracy of this information prior to payment, doing so would strengthen its oversight of the anticipated $6.6 billion in incentive payments. Verifying self-reported information prior to payment could also reduce the need to identify and recover erroneous payments after they are made.”
Problems OIG highlighted including failure to assess whether EPs and hospitals were eligible during the certification process for incentive payments, lack of capability for EHR technology to produce reports for all required measures, lack of guidance as to what documentation is needed to support attestation, and failure to review supporting documentation prior to issuing incentive payments. Furthermore, OIG noted that CMS does not verify that numerators and denominators entered for all percentage-based measures reflect the actual number of given patients for such measures.
Two key recommendations made by OIG to CMS were to review documentation pre-payment, and develop guidance for provider documentation. While CMS does conduct verification during the registration and attestation processes, currently, CMS only will review documentation post-payment during paper and onsite audits.
Notably, CMS rejected OIG’s recommendation for it to implement review of documentation pre-payment citing the increased burden on EPs and hospitals and potential delays in issuing incentive payments. However, CMS did agree with the second recommendation from the OIG requesting that CMS develop guidance with specific examples of documentation which must be produced and retained by participating providers. OIG stated CMS was in the process of developing a FAQ to address documentation which must be maintained.
OIG also recommended that ONC require certified EHR technology be capable of producing reports for measures requiring yes/no, as well as improve the certification process for EHR technology to improve accuracy of reports. ONC agreed with both OIG recommendations.
A key takeaway from this report is that OIG did not address any evidence of improper payments...yet. However, OIG plans to conduct a series of audits of Meaningful Use payments could be an additional burden on participating providers, on top of CMS ramped up auditing. Bolstering its audit intentions as emphasized in its FY 2013 work plan, OIG stated, “These audits will verify the accuracy of professionals’ and hospitals’ self-reported meaningful use information, as well as eligibility and payment amounts.” (emphasis added) How, when, and other important details, like whether OIG will come knocking on your, remain unclear for the moment.