EMR Frauds– Issues Addressed

One of the major concerns while highlighting the drawbacks of Electronic Medical Records (EMR) has been the misuse of confidential patient information. The healthcare industry has suffered a lot in terms of reputation from such incidents in the past. All industry members have condemned these unfortunate events, though the number of reports of abuse compared to the total number of EMR users is relatively low. By and large, the statistics suggest that on the contrary, EMRs have strengthened the system.

EMR adoption has been encouraged vivaciously after the HITECH Act was passed in February of 2009. As a result, there was widespread EMR adoption across the nation. A very important note at this juncture would be to state that financial incentives introduced by CMS for meaningful use of EMRs have had a huge positive impact on the healthcare industry in the US. Processes have become much more streamlined and have been expedited as a result.

Similarly, certain statutory legislations have been passed to protect the rights of all parties involved with the entire electronic medical records user populous. However, there have been cases which illustrate the abuse of private and confidential data. This doesn’t mean that the healthcare system is inherently flawed; there are always some bad fish in the sea. Compromise on the reputation of using electronic medical records is a classic example of one bad fish tarnishing the reputation of the entire pond. Moreover, any individual who believes that the HIPAA Privacy Rule is not being complied with, has the right to file a complaint with the Department of Health and Human Services Office for Civil Rights (OCR). Corrective actions have been taken against such fraudulent events. For instance, as per the report of HHS, a total of 92 medical practices including physicians, practice managers, nurses, and other providers allegedly used EMRs for monetary gains through fraudulent billing processes – thereby culminating in a loss of $225 Million from Medicare funds.

The above mentioned facts demonstrate how the rights of the parties in question have been protected through legislation and the system has been strengthened yet further by the use of electronic medical records. It would be ludicrous to suggest that EMRs provide a platform for abuse; yes there may be some technical slip-ups, but it’s far from being a pathway towards illegal use. That being said, it eventually boil downs to the intent of medical practitioners.

The national coordinator for health IT, Farzad Mostashari, believes that although there will always be incidents of fraud and illegal use of EMRs, there will be legal implications against such frauds. He goes on further to say that appreciating what EMRs have done to strengthen the provision of healthcare is essential. Mr. Mostashari states further that such technology constructs the basis for independent compliance audits and thorough investigations. Therefore, the environment keeps on improving and rectifies its mistakes, and consequently the healthcare industry becomes sturdier.


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