Under the American Recovery and Reinvestment Act of 2009, eligible health providers who demonstrate “meaningful use” of certified electronic health record (EHR) technology can qualify for incentive payments under the Medicare and Medicaid programs. To receive such payments, the eligible provider must attest that it had met certain objectives (e.g., use of computerized provider order entry or exchange of key clinical information between providers electronically) for the prior fiscal year.
According to the federal grand jury indictment, the former CFO falsely attested to the Centers of Medicare & Medicaid Services (CMS) that Shelby Regional met the meaningful use requirements for the 2012 fiscal year. Shelby Regional allegedly relied on paper records during that time, and to give the false appearance that the hospital was actually using EHR, directed its software vendor and hospital employees to manually input data from paper records into the EHR software, often times months after the patient was discharged and after the end of the fiscal year. Because of the false attestation, CMS paid Shelby Regional $785,655. With his guilty plea, the former CFO faces up to five years in federal prison at sentencing.
While the case against Shelby Regional is likely an outlier in several regards (this is one of several civil and criminal investigation against the hospital and related entities), the case highlights the importance of making certain that all meaningful use objectives are met before attesting to the same. The attestation is a legal statement that the supplied “information is true, accurate, and complete,” which can be used against a provider for purposes of civil sanctions, including fines and program exclusion, as well as criminal sanctions.
A careful review of meaningful use attestations is particularly warranted in light of the increasing oversight and enforcement in this area. The federal government has made substantial payments under the Medicare EHR Incentive Program, in excess of $63,000,000 as of September 2014, and it should not come as a surprise that now, several years into the program, the government is ramping up efforts to maintain the program’s integrity. Since 2013, CMS has been engaged in pre-payment audits and more, recently with post-payment audits of thousands of providers. Providers selected for these audits have to provide supporting documentation to validate the attestation of compliance or risk, among other things, recoupment of the incentive payments.
More recently, the Office of Inspector General (OIG) identified in its 2015 Work Plan that it “will review Medicare incentive payment data from 2011 to identify payments to providers that should not have received incentive payments (e.g., those not meeting selected meaningful use criteria).” Exactly how the OIG plans to conduct this review is not yet clear.
