Policy & Value-Based Care

OIG Report Critical of CMS in EHR Incentive Program

June 25, 2013

A new report from the Office of the Inspector General (OIG) has determined that the Centers for Medicare & Medicaid Services (CMS) faces obstacles in the Medicare EHR incentive program because it does not verify whether the self-reported information from providers is accurate and thus the integrity of the program is in question. The OIG charges CMS with not implementing “strong prepayment safeguards,” in the 38-page report, released this week.

Gabriel Perna

A new report from the Office of the Inspector General (OIG) has determined that the Centers for Medicare & Medicaid Services (CMS) faces obstacles in the Medicare EHR incentive program because it does not verify whether the self reported information from providers is accurate and thus the integrity of the program is in question. The OIG charges CMS with not implementing “strong prepayment safeguards,” in the 38-page report, released this week.

According to the OIG, while CMS’ prepayment validation is correctly, it does not verify that self reported information is accurate. Specifically, the report’s authors write that CMS does not verify that “numerators and denominators entered for percentage-based measures reflect the actual number of patients for a given measure or that professionals and hospitals possess certified EHR technology.”

The report was an early assessment of the CMS EHR incentive program, which will pay an estimate $6.6 billion in incentives to meaningful users of the technology from 2011 to 2016. The OIG said it reviewed CMS’ oversight of professionals' and hospitals' self-reported meaningful use of certified EHR technology in 2011, the first year of the program. It analyzed self-reported information and reviewed audit planning documents, regulations, and guidance. It also conducted interviews with the CMS on its oversight of the program.

OIG recommended in the report that CMS obtains and reviews documentation to verify the self reported data. It also says CMS should issue guidance on this kind of documentation and how it supports their compliance. According to CMS, however, the first recommendation “would increase the burden on practitioners and hospitals and could delay incentive payments.”

In addition, OIG recommended that the Office for the National Coordinator for Health IT (ONC) require certified EHR technology be capable of producing reports for yes/no meaningful use measures where possible and improve the certification process for EHR technology.