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July 26, 2017

Senators to CMS: Are you trying to recover $729M in wrongful EHR payments?

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Two Republican senators in a letter sent earlier this month asked CMS whether CMS is capable of recovering more than $700 million in overpayments under the meaningful use program, and if so, what actions the agency plans to take to collect them.

The road to the largest public health EHR implementation


An HHS Office of the Inspector General (OIG) audit released last month found Medicare wrongfully distributed a total of $729.42 million in EHR incentive payments to physicians and other health care professionals over a three-year period.

OIG identified 14 cases in which CMS paid health professionals a total of $291,222 in EHR incentives payments even though the professionals did not meet meaningful use requirements because they provided inadequate evidence, inappropriately reported meaningful use periods, and/or did not sufficiently use EHR technology.

Further, OIG identified 471 health care professionals who switched between Medicare's and Medicaid's EHR incentive programs and did not meet the appropriate federal requirements for that program year, but received payments, which totaled $2.34 million.

According to Healthcare IT News, OIG intends to further investigate payments CMS issued under its EHR incentive programs. Specifically, OIG will review the accuracy of Medicare incentive payments awarded to hospitals that adopted EHRs from Jan. 1, 2011, through Dec. 31, 2016. CMS payments to such hospitals over the five-year period totaled $14.6 billion, according to OIG.

Sens. say CMS has not taken action to recoup overpayments

The letter, sent by Senate Finance Committee Chair Orrin Hatch (R-Utah) and Senate Judiciary Committee Chair Chuck Grassley (R-Iowa) asked CMS Administrator Seema Verma for information on the actions CMS has taken to address the issues raised in the OIG audit.

The senators requested:

  • A description of how targeted-risk audits will help recover and prevent inappropriate payments going forward;
  • An explanation of why CMS has "not made greater attempts to recover" the $729.42 million in improper EHR incentive payments;
  • An update on in the amount of improper payments CMS has recovered; and
  • Details on whether CMS has attempted to review a random sample of self-attested documents to identify any inappropriate payments since the audit was released.

The senators asked Verma to respond to their requests by July 31 (Kuhrt, FierceHealthcare, 7/14; Siwicki, Healthcare IT News, 7/18; Monica, EHR Intelligence, 7/19; Grassley and Hatch letter, 7/12).

Why the EHR life cycle is just like raising a child

Why the EHR life cycle is just like raising a child

A successful EHR system requires budget, resources, and planning—not only before it goes live, but after as well.

In fact, the process of implementing, deploying, maintaining, and optimizing an EHR system is similar to that of raising a child—each stage of the process requiring a unique subset of people to ensure its success. Learn more about the seven stages of the EHR life cycle in this infographic.

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