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Senators Urge CMS to Recover MU Overpayments

July 18, 2017
by Rajiv Leventhal
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Sens. Hatch and Grassley also press the agency to answer several questions regarding the OIG report from last month

Two U.S. senators are advocating for the Centers for Medicare & Medicaid Services (CMS) to recover meaningful use overpayments that the government mistakenly doled out over a recent three-year span, as estimated in a recent report from the Office of Inspector General (OIG).

During a three-year span starting in 2011, CMS overpaid an estimated $729 million in Medicare electronic health record (EHR) incentive payments to eligible professionals (EPs) who did not comply with federal meaningful use requirements, according to a report released last month from the Department of Health and Human Services’ Office of Inspector General. In addition, CMS paid $2.3 million in inappropriate EHR incentive payments to eligible professionals who switched incentive programs, according to the report from OIG, the largest inspector general's office in the federal government.

For the report, OIG randomly sampled 100 EPs who received at least one payment during the three-year audit period and reviewed support for their attestations to meaningful use measures—as well as a review of all payments made to deceased EPs and to EPs who switched between Medicare and Medicaid programs.

OIG revealed that CMS did not always make EHR incentive payments to EPs in accordance with federal requirements. Specifically, on the basis of the sample of 100 EPs, OIG identified 14 EPs with payments totaling $291,222 that did not meet the meaningful use requirements “because of insufficient attestation support, inappropriate reported meaningful use periods, or insufficiently used certified EHR technology.” On the basis of these sample results, OIG estimated that CMS inappropriately paid $729,424,395 in incentive payments to EPs who did not meet meaningful use requirements—or 12 percent of total payments made in this time period.

Further, OIG also said that CMS made EHR incentive payments that were not in accordance with the program-year payment requirements when EPs switched between Medicare and Medicaid incentive programs. Specifically, they identified 471 EHR incentive payments totaling $2,344,680 that CMS made to EPs for the wrong payment year.

Given the findings, OIG offered several recommendations to CMS, all of which CMS partially or completely concurred with. The agency also said in a statement, “This Administration is committed to turning the page and ushering in a new era of accountability.  Providing high-quality care to Medicare beneficiaries while being responsible stewards of taxpayer dollars remains a top CMS priority, and we recognize the value data validation and auditing bring to our programs.”

But now, in the letter to CMS Administrator Seema Verma, Sens. Orrin Hatch (R-UT) and Charles Grassley (R-IA) said that “If CMS Is capable of recovering taxpayer money that should not have been spent, the agency should take all reasonable steps to do so.” It continued, “If it is incapable of recovering the money, Congress should know about these limitations.”

The letter also requested a response from CMS in regards to several questions: how much of the $291,222 in overpayments to 14 EPs has been recovered; why CMS has not made more of an effort to recover the MU overpayments; if CMS has attempted to review the sample of EPs’ self-attestation documentation to identify inappropriate payments that may have been made after the audit period; how much of the $2,344,680 in overpayments made to EPs after they switched programs has been recovered; how targeted-risk audits will work to recover inappropriate payments already made and prevent them from being made in the future.

It should be pointed out that OIG only sampled 100 EPs to come up with its estimate of $729 million in program overpayments, leading to questions on whether the sample is a true representation of the bigger picture. What’s more, as Jeff Smith, vice president of public policy at the American Medical Informatics Association (AMIA), noted in an article that followed up on the OIG findings, the findings could be a problem of EPs failing to provide sufficient enough proof when audited as opposed to EPs receiving totally inappropriate payments.

The senators said that they would like answers to these questions by the end of July.

What’s more, according to an updated OIG work plan, the department will soon review Medicare EHR incentive payments to hospitals from 2011 to 2016, totaling $14.6 billion (this prior report did not include eligible hospitals). Previous OIG reviews of Medicaid EHR incentive payments found that state agencies overpaid hospitals by $66.7 million and would in the future overpay these hospitals an additional $13.2 million, according to a summary of the work plan.

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