OIG delivers a wake-up call to providers who misuse EHR shortcuts

Tools

Well, after last week's brouhaha over the fact that electronic health records may facilitate upcoding and other inappropriate billing, it should come as no surprise that EHRs figure prominently in the Office of Inspector General's 2013 work plan, which was released this week.

The annual work plan summarizes the new and ongoing reviews and activities that the OIG plans to pursue during the next year to protect the integrity of HHS programs and operations and "hold accountable those who do not meet program programs or who violate Federal laws." The majority of its resources go to protecting the Medicare and Medicaid programs and its beneficiaries.

The OIG's focus on EHRs in its 2013 work plan is not all that different from its 2012 work plan, which for the first time said that OIG would review fraud vulnerabilities presented by EHRs. The 2012 work plan also raised concerns about identical documentation for evaluation and management services, made easier by EHRs' cut-and-paste function; review of the incentive payments under the Medicare and Medicaid EHR incentive programs; and several projects related to protecting patient information pursuant to the Health Insurance Portability and Accountability Act (HIPAA), which also involves EHRs more than ever with trend away from paper records.

The 2013 work plan doesn't deviate from these areas of focus.

But what's interesting is how many of them are identified as "works in progress," which means that the OIG is already hard at work on that project and could issue its report on it at any time.

The OIG always sets out an ambitious agenda that covers a lot of ground. The OIG reports in the 2013 work plan that for fiscal year 2011, it recovered about $5.2 billion from audit and investigative receivables and created $419.8 billion in savings as a result of legislative, regulatory or administrative actions supported by OIG's recommendations.

There were exclusions of 2,662 individuals and entities from participation in federal health care programs; 723 criminal actions against individuals or entities that engaged in crimes against HHS programs; and 382 civil actions, which included false claims and unjust-enrichment lawsuits, civil monetary penalty settlements, and administrative recoveries related to provider self-disclosure matters.

But since OIG can't complete every task in its annual work plan, it tends to hold over those agenda items it didn't have a chance to complete.

I predict that the OIG will stop holding EHR projects over and that 2013 will be the year that OIG takes action on EHR use. With MACs and RACs audits focusing on EHR billing, the incentive program in full swing, the uptick in EHR adoption rates and increased public awareness of EHRs, the time is ripe for it--espeicially with HHS Secretary Kathleen Sebelius and Attorney General Eric Holder sending warning letters to provider groups that EHR billing fraud and abuse will not be tolerated.

The work plan is always an important indicator as to where hospitals, physicians and other providers should be beefing up their compliance efforts. Providers should take this latest report as a wakeup call. - Marla