Flaw in Electronic Health Record System Leads to Overcharging

Friday, January 10, 2014

With the encouragement of the Obama administration, doctors and healthcare facilities have been digitizing patient files to create electronic health records (EHR). But in doing so, some practitioners have been overcharging Medicare, which hasn’t adopted sufficient safeguards to prevent this from happening.


The federal government is spending more than $22 billion to encourage the creation of EHRs in the health industry. But this investment has not included policies or resources to keep Medicare from paying physicians more than it should for services that suddenly become inflated after the digitizing of records, according to the Office of the Inspector General (IG) for the Department of Health and Human Services.


In its second report (pdf) on the subject in just two months, the IG stated that despite spending “considerable resources to promote widespread adoption of E.H.R.’s,” the government has “directed less attention to addressing potential fraud and abuse.”


Further, Medicare has not altered its policies or procedures for detecting fraud, while providing its contractors “with limited guidance” on the matter, the report said.


A key problem discussed by the IG involves medical professionals’ use of cloning, which is a copy-and-paste function that helps speed up the converting of records from paper to electronic. But this process also can be abused to allow doctors to indicate a procedure was more expensive than it actually was, resulting in overcharges to Medicare.


The IG’s report did not put a price on the amount of fraud that may be occurring. But The New York Times reported that “earlier government estimates have said it could run in the hundreds of millions of dollars.”


Some industry professionals admit that the digitizing effort may be resulting in costly mistakes for the government.


“We’re continuing to see the use of cut-and-paste in health care organizations because clinicians find it is one of the only ways they can manage the documentation process,” Michelle Dougherty, senior director of research and development at the American Health Information Management Association, a group that focuses on improving the quality of health information, told the Times. “But there is the potential that there is information being copied that is not relevant or even erroneous.”


The IG issued another report (pdf) last month that found 75% of hospitals surveyed had no formal policy surrounding the use of copy-and-paste for electronic health records.


Medicare officials responded to the criticism saying fraud prevention was “a top priority” for the agency.


“We are working to create strong standards for validating electronic health records to ensure that we allow beneficiaries to receive the care they need and at the same time protect taxpayers from fraud waste and abuse,” Medicare said in a prepared statement.


Electronic data entry that is performed “on-site” is also having a negative impact on patient care. One study released last fall, which focused on a community hospital emergency room, found that physicians spent 43% of their time in the ER entering data (clicking 4,000 times during a single 10-hour shift), leaving them to directly tend to their patients only 28% of the time.

-Noel Brinkerhoff


To Learn More:

Report Finds More Flaws in Digitizing Patient Files (by Reed Abelson and Julie Creswell, New York Times)

CMS and Its Contractors Have Adopted Few Program Integrity Practices To Address Vulnerabilities in EHRS (Department of Health and Human Services, Inspector General) (pdf)

Not All Recommended Fraud Safeguards Have Been Implemented in Hospital EHR Technology (Department of Health and Human Services, Inspector General) (pdf)

VA and Defense Dept. began Paying for New Records System while still Funding Abandoned One (by Noel Brinkerhoff, AllGov)


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