According to a report released by U.S. Department of Health and Human Services’ Office of Inspector General, the Centers for Medicare and Medicaid Services have actually overpaid more than $729 million worth of incentive payments to eligible providers that failed to meet meaningful use requirements.
The officials said that this happened because the sample of eligible providers failed to maintain support for attestations. It should be noted that the amount i.e. $729 million is roughly about 12 percent of the total incentive payments reserved for providers using electronic health records.
The Office of Inspector General further said that CMS also failed in conducting minimal documentation reviews. This left the incentive program open to abuse and caused misuse of federal funds.
It was also reported that CMS made $2.3 million in EHR incentive payments and didn’t adhere to program-year payment requirements for providers who were switching from Medicaid to Medicare incentive programs. This happened because CMS failed to ensure that all providers who switched programs were in the correct payment year or not.
Officials have stated that CMS should recover the $700 million in inappropriate incentive payments along with $2.3 million of overpayments paid to the providers who switched programs. The department further said that CMS should review more random samples of provided self-attestation documentation in order to see whether any further inappropriate payments were made after the auditing period or not.
U.S. Department of Health and Human Services also opined that CMS should also work on educating providers on documentation requirements. CMS must also edit the National Level Repository system to ensure providers aren’t receiving payments for both programs even after they have switched programs.
The officials recommended that as CMS implements MACRA, it should also make necessary modifications to the EHR meaningful use requirements and include stronger program integrity safeguards that would ensure more consistent verification of reporting.