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CMS incentive program overpaid more than $700 million to participants, according to OIG


The Center for Medicare and Medicaid Services (CMS) overpaid $729 million to eligible professionals as part of an incentive program, according to a U.S. Department of Health and Human Services' Office of Inspector General audit released Monday. 

CMS had paid out more than $6 billion for their Electronic Health (EHR) Incentive Program to professionals as of June 2014, meaning about 12 percent of the total payments were wrongly paid to those who did not meet requirements. 

Eligible professionals, which could include dentists, physicians, chiropractors, podiatrists, or any hospitals that are Medicare eligible, were supposed to enter supporting data to CMS online to certify they met requirements. According to the report, this was not always the case and CMS largely did not review the documentation. 

"These errors occurred because sampled EPs did not maintain support for their attestations. Furthermore, CMS conducted minimal documentation reviews of self-attestations, leaving the EHR program vulnerable to abuse and misuse of Federal funds," the audit states. 

The purpose of the EHR Incentive Program is to help professionals implement or upgrade their EHR technology in order to improve the quality and efficiency of health care, and to promote health information technology, according to the CMS website. 

On top of the $700 million in overpayments, the audit found more than $2.3 million was wrongly paid to professionals who had switched programs. Program participants may choose to receive incentive payments from either Medicare or Medicaid, but when professionals switched programs CMS did not have a sufficient system to track how many years the professional had been in the program, which resulted in the overpayments. 

OIG also found during their audit that 11 deceased professionals were still active in the CMS system, and in one case had wrongly paid about $11,000 to someone who was deceased. 

The audit was conducted by randomly surveying 100 participants who had received incentive payments between 2011 and 2014. Through this sample, they found $291,222 had been paid to 14 participants that did not meet the requirements. They were then able to estimate that more than $700 million had been overpaid. 

OIG recommends CMS attempt to recover the total amount of money that was overpaid and also change the system to prevent the same problems from happening in the future. CMS largely agreed with the recommendations. 

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