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CMS overpaid nearly $730 million in meaningful use incentives, OIG says

Failure to conduct minimal documentation reviews left the incentive program open to abuse of federal funds, agency says.

Jessica Davis, Associate Editor

The Centers for Medicare and Medicaid Services overpaid more than $729 million in incentive payments to eligible providers that didn't meet meaningful use requirements, according to a U.S. Department of Health and Human Services' Office of Inspector General report released Monday.

The amount -- about 12 percent of the total incentive payments for electronic health record incentive payments -- occurred because the sample of eligible providers didn't maintain support for attestations, officials said.

CMS also failed to conduct minimal documentation reviews, which officials said left the incentive program open to abuse and misuse of federal funds.

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The agency also made $2.3 million in EHR incentive payments that didn't adhere to program-year payment requirements when providers switched from Medicaid to Medicare incentive programs. Officials said this is because CMS did not ensure those providers who switched programs were in the correct payment year.

OIG recommends that CMS return the $291,000 in payments to the sampled providers who failed to meet meaningful use requirements and review all incentive payments determine the providers that failed to meet meaningful use measures for each applicable program year.

Officials said that CMS should attempt to recover the more than $700 million in inappropriate incentive payments and $2.3 million in overpayments to the providers who switched programs.

CMS should also review more random samples of provided self-attestation documentation to identify any further inappropriate payments that may have been made after the auditing period.

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Officials said CMS should also educate providers on documentation requirements, while editing the National Level Repository system to make sure providers aren't receiving payments for both programs after they switch programs.

CMS agreed and partially agreed with the recommendations, and officials said it's implemented targeted risk-based audits to strengthen the integrity of the program. OIG stressed, "Targeted risk-based audits are not capturing errors such as those identified in this report."

"As CMS implements MACRA, we recommend that any modifications to the EHR meaningful use requirements include stronger program integrity safeguards that allow for more consistent verification of the reporting of required measures," officials said in a statement.

Twitter: @JessiefDavis