The department must do more ensuring integrity of MU program and driving interoperability efforts, says OIG
A report from HHS' Office of Inspector General outlines the top challenges faced by the Department of Health and Human Services in FY 2014. Among them: meaningful use and interoperability. The office also highlighted several areas HHS continues to struggle with heading into 2015, including electronic health records.
First, HHS oversight of the EHR Incentive Programs has been significantly lacking and ultimately "vulnerable to inappropriate payments to participants that do not meet program requirements." The Centers for Medicare & Medicaid Services, for instance, has paid out more than $25.4 billion in incentives payments to eligible hospitals and providers that have demonstrated meaningful use, but have failed to implement adequate controls ensuring that those participants were actually entitled to the federal money.
[See also: CMS called out for EHR fraud failings.]
OIG officials cited the case of Louisiana Department of Health and Human Services, which just this September was found to have wrongly claimed $3.1 million in EHR incentive payments. OIG had examined the state's payouts in 2011 and subsequently found that LDHHS overpaid 13 hospitals $3.1 million and underpaid six hospitals $1.3 million. Overall, some 80 percent of Louisiana hospitals analyzed in the audit failed to comply with federal regulations or guidance.
What's more, as the report outlined, CMS also hasn't done enough prepayment audits and instead has relied predominantly on post payment audits for "high-risk participants," which has proved insufficient in preventing things like fraud.
In a report earlier this year, OIG called out CMS for its shortcomings in identifying and investigating EHR fraud. These deficiencies, as they pointed out, helped contribute to the estimated $75 billion to $250 billion in healthcare fraud.
In that report, they highlighted two of the most common EHR documentation practices used to commit fraud: copy and paste, by which a healthcare provider copies and pastes information from a patient's record multiple times, often failing to update the data or ensure accuracy, and over-documentation, which involves adding false or "irrelevant documentation to create the appearance of support for billing higher level services."
What's more, many of CMS' audit contractors were unable to determine whether a provider had even used copy and paste.
[See also: EHR copy and paste? Better think twice.]
Beyond the oversight and control issues HHS needs to address with meaningful use, OIG officials also pointed to serious challenges with interoperability. "The department must do more to ensure that systems are interoperable in order to realize these goals," wrote OIG officials in the report. This includes technical assistance, guidance and adopting policies that facilitate this.
The Office of the National Coordinator for Health IT has made some progress with this, establishing its 10-year interoperability roadmap. Still, many stakeholders say it lacks teeth.
[See also: ONC sees 10 years of quality improvement.]
"Where are the teeth with interoperability?" asked Marc Probst, CIO of Intermountain Healthcare, at a press briefing Sept. 16 on Capitol Hill. "With meaningful use, we had teeth. We had something we could get out there. We had benefits, incentives, and we had penalties."
Probst, a member of the Health IT Policy Committee, has been one of the most outspoken voices on the topic of interoperability advancement. "It does all come down to these fundamental standards," he added. "We've got to sit down and say,'what's the standard, and how are we gonna move it?'"
