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Don't Overlook Fraud in EHRs, OIG Cautions CMS

Jacqueline Fellows, for HealthLeaders Media, January 9, 2014

CMS primarily uses three types of contractors to help prevent fraudulent claims:

  1. Zone Program Integrity Contractors (ZPICs)
  2. Medicare Administrative Contractors (MACs)
  3. Recovery Audit Contractors (RACs)

Using online questionnaires, OIG officials asked all three types of CMS contractors' questions aimed at determining how each one had modified its anti-fraud efforts for EHRs. A total of 18 CMS contractors participated, and the OIG report notes it had a 100% response rate from all 18.

According the report's findings, ZPICs were able to more often identify when a provider used the copy and paste function, as well as overdocumenting in an EHR. ZPICs are more focused on investigating Medicare fraud than MACs, which are claims processors and payers, and RACs, which identify improper payments; however, all three contractors play an important role in fighting fraud and abuse.

At issue is whether these CMS contractors are able to apply the same type of scrutiny to EHRs as paper claims. With EHR adoption increasing, it's important that these contractors be able find flaws easily, says Riza Dagli, a partner at New Jersey law firm, Brach Eichler. Dagli also previously held positions in New Jersey as the Director of the Medicaid Fraud Control Unit and Acting Insurance Fraud Prosecutor.

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