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05-11-2012 | Article

Fraudulent electronic health record use under scrutiny

Abstract

Department of Health and Human Services

medwireNews: An increase in electronic health record (EHR) use along with inflated Medicare billing has prompted federal action by the Department of Health and Human Services.

In an October 24, 2012 video presentation outlining priorities as part of Office of Inspector General (OIG) outlook 2013, Daniel Levinson, the Department of Health and Human Services Inspector General, emphasized a federal crackdown on the fraudulent abuse of EHRs with regard to Medicare overbilling.

The push for investigative oversight has quickly picked up over the past few months following a year-long investigation by The Center for Public Integrity that found a steady increase in billing rates over the past decade by medical professionals who treat seniors on Medicare.

An estimated minimum of $ 11.0 billion is being questioned on account of inflated fees. Federal investigation will enquire whether the notable increase in Medicare charges is being facilitated by the billing system provided by EHR technology.

"Electronic medical records can improve quality of care and efficiency and help us uncover cases of fraud and abuse," said Daniel Levinson in the presentation. "At the same time, we must guard against the use of electronic records to cover up crime."

In a letter sent to five major hospital trade associations on September 24, 2012, Attorney General Eric Holder Jr and the Health and Human Services secretary, Kathleen Sebelius, noted "troubling indications" that certain health providers are using EHRs to "game the system" by obtaining "payments to which they are not entitled to."

The 2009 Health Information Technology for Economic and Clinical Health (HITECH) Act - a program that provides $ 30.0 billion in assistance to purchase digital record keeping systems - provided the incentive for doctors and hospitals to adopt the use of EHRs.

Its aim is to encourage effective use of EHR to improve care coordination, reduce healthcare disparities, and better engage patients. According to the National Coordinator for Health Information Technology, Dr Farzad Mostashari, EHR use has proven to significantly increase basic standards of care compared with paper-based record keeping.

Yet a New York Times analysis of American Hospital Directory data found that hospitals received $ 1 billion more in Medicare reimbursements in 2010 compared with 5 years earlier; an increase that is partly due to a change in the billing codes assigned to patients. Noting the increase in Medicare billing errors and abuses, Mostashari has initiated an internal review in the Department of Health and Human Services to ascertain whether EHRs are motivating some doctors and hospitals to overbill Medicare.

By Peter Sergo, medwireNews Reporter