OIG: CMS not doing enough to prevent fraud in EHRs
The Centers for Medicaid & Medicare Services (CMS) and contractors are not doing enough to address vulnerabilities within EHR systems that make them susceptible to fraud, according to the Office of the Inspector General (OIG).
OIG sent an online questionnaire to CMS administrative and program integrity contractors who use EHRs to pay claims, identify improper Medicare payments and investigate fraud. The investigative body also studied related CMS policies and guidance documents, and reviewed documents on EHRs and Medicare claims that CMS provides to its contractors.
OIG concluded the following:
- CMS and its contractors had adopted few program integrity practices specific to EHRs
- Not all contractors reported being able to determine whether a provider had copied language or overdocumented in a medical record
- CMS provided limited guidance to contractors on EHR vulnerabilities
The report recommends that: (1) CMS provide guidance to its contractors on detecting EHR-associated fraud and (2) CMS direct contractors to use providers’ audit log data. The OIG said that CMS agreed with the first recommendation and partially on the second.
Read the report here.