EMR frauds – the Issue Needs Attention!

Fraudulent use of Electronic Medical Records (EMRs) is under a lot of scrutiny within the healthcare industry. From health IT consultants to healthcare professionals to government’s regulatory bodies, almost everyone has taken the matter seriously. After all, EMRs were designed to ensure precision and quality in care delivery and never to encourage any fraudulent occurrences.

Considering the extent of fraudulent use of electronic medical records, it would not be difficult to proclaim that some healthcare professionals have deviated from the axiom of transparent provision of quality care at low cost. Moreover, it would certainly be “unreasonable” to blame the CMS’ financial incentive programs for instilling the urge of cheating and greediness amongst physicians.

It is important to realize that the financial incentives were offered on the basis of Meaningful Use of certified EMRs and I quote, “in a legal manner”.  According to official reports of HHS, 92 defendants including doctors, nurses, and other healthcare providers have been alleged for fraudulent use of EMRs related to billing purposes – resulting in $225 million for the Medicare funds. (For more details visit HHS).

According to the billing reports of the past decade, it becomes evident that physicians have been biased in submitting medical bills. The clinical procedures that resulted higher in monetary benefits were significantly given more priority, while the ones with negligible benefits were ignored. (Source: Fierce EMR)

Furthermore, it would also be absurd to blame the EMRs for these fraudulent occurrences. When it comes to IT products, some glitches and technical errors do exist but that doesn’t mean that they create a gateway to illegal usage. At the end of the day, the idea of usage, by all means depends upon the intent of use of healthcare providers.

Farzad Mostashari, the national coordinator for Health IT, says that there have always been people who commit frauds and there are always going to be enforcement against these frauds. In addition, lauding the significance and not blaming the EMRs, he proclaimed that it is such technology that constructs the base of stronger investigations and enforcement.


The Meaningful Use Surprises

The final rule for meaningful use stage 2 should be out any day now and while most of care community anxiously awaits the announcement, the industry experts are expecting little to no changes from the proposed rule, released earlier this year. The stage two of meaningful is to build on the stage one objectives ensuring that providers are able to utilize EMR technology in a constructive manner and add value to the care process. The focus of the second stage will be on ‘advanced clinical processes’. Keeping in line with this theme, stage 2 is expected to feature clinical decision support, electronic data sharing and patient engagement as its main components.

Farzad Mostashari, the National Coordinator for Health Information Technology admitted that there could be some surprises in store for providers looking to attest for the meaningful use stage 2 saying, “I think that it would probably come as a little surprise we will pushing on standards based exchange and on patient engagement aspects in addition to continuing really what was in stage 1.”

Health information Exchange seems to be the most significant concern at this point in time. Providers were aghast with the proposed rule and its interoperability requirements, with most admitting that there electronic medical records simply did not possess the capability to comply with stage 2. There was a definite gap between the technology available to providers and what CMS was anticipating. Dr. Mostashari in response to the concerns raised by the medical community expressed that the ONC does listen to the concerns carefully. He explained, “We have been at this for a while now and we have to really balance the needs of the situation against how fast the industry and providers can adapt to change.”

The ONC has also outlined a plan for standardizing health information exchange and will seek to accomplish three major aspects within this year, which includes a common set of rules for governance of HIEs. This also reflects the CMS stance on health information security with the meaningful use stage 2 proposed requirements.

Patient engagement is an important aspect of the healthcare reform. With the government set on introducing a preventive care culture across the nation, health system interoperability will undoubtedly benefit patients by making care more accessible and affordable. The proposed stage 2 rule adds follow-up reminders, patient education and patient access to electronic medical records as core measures. The public response has been positive with patients being allowed to access their own information for downloading and personal use.

While there has been no indication as to whether CMS has relaxed the attestation period from one calendar year to 90 days as suggested by AHA, most providers are hoping for some sort of relief from the authorities. For now it seems that the best bet is to make sure that you retain what you have learned during the first attestation period and go from there.