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MU Audit Fears Escalate as HMA Returns $31M

 |  By smace@healthleadersmedia.com  
   November 07, 2013

Meaningful Use audit-related givebacks and penalties can pack a much harder punch than other Medicare audits, says the CEO of CHIME, because failure in one area of MU attestation is perceived by auditors as "failure in aggregate."

Concerns that Meaningful Use auditors have unclear expectations of their targets were heightened by reports this week that the 70-hospital Health Management Associates (HMA) is giving back approximately $31 million of Medicare and Medicaid payments to the federal government.

Last month, based on the results of an internal review, HMA determined that it had made an error in applying the requirements for certifying its EHR technology under these programs and, as a result, that 11 of the hospitals it had enrolled in the HIT programs did not meet the Meaningful Use criteria necessary to qualify for payments.


See Also: Latest Wave of MU Audits Delivers a Fresh Scare


Russ Branzell, CEO of the College of Healthcare Information Management Executives (CHIME), expressed concern that Meaningful Use audit-related givebacks and penalties can pack a much harder punch than other Medicare audits.

"If you mess up one bill for Medicare, and you're in a RAC audit, and they ask you to correct that one bill, they don't tell you to give back all your Medicare money," Branzell says.

A "Failure in Aggregate"
Meaningful Use auditors, on the other hand, possess a mindset that failure in one area of Meaningful Use attestation is "failure in aggregate," leading to much larger potential givebacks such as HMA's.

"Now if they're appropriately finding things that are of concern, like you would with any audit, then we welcome that scrutiny," Branzell says. "If they're auditing without a standard, rigid process they're following for consistency across all their audits, with some clear expectations, then we will be concerned, which we were the first time, and we made sure that was very well-expressed to the powers that be in Washington."

The latest round of Meaningful Use audit notices, which bore response dates of November 7, first appeared as emails from designated auditing firm Figliozzi and Company to providers during CHIME's most recent conference in October.

"More Pervasive" Audits Coming
Branzell says based on the responses Figliozzi receives, the firm will decide how many on-site followup audits would then occur. These on-site audits "will eventually be much more pervasive" than they have been so far, Branzell says.

CMS is required to audit a certain number of organizations or individuals that have attested for Meaningful Use, Branzell says. "I do think there's an appropriateness to audit," he says. "We just want to make sure it's done correctly."

So far, CMS is unwilling to consider granting "partial credit" for Meaningful Use attestations that fall just short of meeting minimum criteria, Branzell says. "I don't think they're going to bend on this, just the way it was set up," he says. "At least at this point they won't."

Branzell says he was not aware of which electronic health record system or systems were in use at HMA. "I would expect that they have a pretty robust IT staff," he says. He did note, however, that the corporate leadership listed at HMA's Web site does not list a chief information officer.

"It does make you wonder if there was one, and that person is gone, or if they didn't have one, and they were sourcing their IT somewhere, and that might have been part of the problem," Branzell says. "At this point, we really don't know."

Scott Mace is the former senior technology editor for HealthLeaders Media. He is now the senior editor, custom content at H3.Group.

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