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Don't Overlook Fraud in EHRs, OIG Cautions CMS

Jacqueline Fellows, for HealthLeaders Media, January 9, 2014

Their efforts seem to have paid off with multi-million dollar settlements and near-daily headlines touting the takedown of a fraudulent healthcare provider. According to CMS spokesperson, Rachel Maisler, the most recent figures available show year over year increases in penalties.

"Healthcare fraud prevention and enforcement efforts recovered a record $4.2 billion in taxpayer dollars in Fiscal Year (FY) 2012, up from nearly $4.1 billion in FY 2011, from individuals and companies who attempted to defraud federal health programs serving seniors and taxpayers or who sought payments to which they were not entitled," says Maisler.

But the OIG's new report exposes weaknesses of contractors who either do not understand or realize the risk of fraud that emerging technology carries when not protected properly. According to the OIG's findings, some contractors couldn't tell if a medical record contained too much information, which could lead to overbilling, or if a provider copied and pasted information, which could lead to improper billing.

In addition, OIG said in the report that "…CMS had provided limited guidance to Medicare contractors on EHR fraud vulnerabilities."

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