Government Watchdog Agency Calls for Medicare to Recoup Overpayment of EHR Bonuses


The HHS Office of Inspector General (OIG) has released an audit report on $6 billion paid to 250,000 clinicians in the incentive program for meaningful use of EHRs from May 2011 to June 2014. A random sample of 100 clinicians who had received at least one incentive payment revealed that 14 of them who had collected some $291,000 had not met all meaningful use requirements as they had attested.

  • Six clinicians couldn't provide a mandatory analysis of security risks
  • Four clinicians couldn't prove that they had generated at least one list of patients — another requirement — who had the same condition
  • Three clinicians could not provide patient encounter data to document that they had met various meaningful use measures
  • One clinician had 90-days' worth of patient encounter data when a year's worth was needed
  • One clinician did not use certified EHR technology as much as required

Based on this sample, the OIG estimated that the Centers for Medicare and Medicaid Services (CMS) paid out $729 million in bonuses to clinicians who did not earn them. Accordingly, the OIG recommended that CMS recover the $291,222 improperly paid to the clinicians in the sample group.

More significantly, it said that CMS should audit all meaningful use bonuses over the 3-year stretch to identify all undeserving clinicians and recoup the $729 million in mis-payments. Furthermore, the OIG recommended that CMS review a random sample of meaningful use documentation to identify any mis-payments after June 2014.

Responding to a draft of the report, CMS said it concurred with the first recommendation, but only partially concurred with the second and third, saying that it had begun to perform targeted, as opposed to wholesale, audits of bonus payments. The OIG responded that despite demurrals from CMS, it still recommended going after the $729 million and spot-checking meaningful use documentation beyond the audit's time frame.

There were other OIG recommendations, all of which CMS endorsed. One of them called for recouping $2.3 million in meaningful use bonuses — apart from the $729 million — that CMS mistakenly doled out through no fault of the clinician.

The last year in which clinicians and hospitals received meaningful use bonuses was 2016.

CPMA is strongly opposes the wholesale clawback of meaningful use bonuses, and is carefully monitoring this issue.

(Source: Robert Lowes, Medpage[6/13/2017])