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OIG report: EHR incentive program lacks prepayment, auditing protocols

The federal agencies overseeing the electronic health record incentive program have not included enough safeguards to protect against misappropriation of meaningful use dollars, according to a new report by the Office of the Inspector General (OIG).

Information submitted by eligible hospitals and providers for the Medicare portion of the incentive program is all self-reported. The Centers for Medicare & Medicaid Services (CMS) does not conduct sufficient prepayment protocols to ensure that self-reported data is accurate and honest, OIG said in its report. The agency can’t verify data before payment because it lacks access to verification databases.

In addition, while the HITECH Act requires participants in the EHR program to retain supporting documentation when they attest to meaningful use, the CMS does not provide enough guidance in detailing what type of documents health organizations should keep.Audits conducted after incentive payments are made cannot conclusively find whether the providers are indeed meaningful users of EHRs due to this oversight.

OIG also scrutinized the Office of the National Coordinator for Health IT’s (ONC) certification practices, finding fault with vendor development of EHR reports. The report said inaccuracy in reporting affects the ability of providers to create supporting documentation.

Both the CMS and ONC said they are incorporating OIG’s suggestions for strengthening the auditing process and EHR reports as they finalize plans for stage 2 of meaningful use. The CMS in a letter disagreed with OIG’s recommendation that the agency require more supporting documentation during the prepayment process, saying that such a requirement would over burden providers in the attestation process and could delay incentive payments.

This is the second OIG report to criticize the CMS recently for falling short of standards set through the HITECH Act.

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