EHR Adoption Leading to Increasing Incidence of Medical Billing Fraud


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Implementing EHR in hospitals has increased the rate of medical billing error and fraud.
Medicare is taking strong measures to address these issues.

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EHR Adoption Leading to Increasing Incidence of Medical Billing Fraud

  1. 1. EHR Adoption Leading to Increasing Incidence of Medical Billing Fraud Healthcare providers are racing ahead to implement Meaningful Use of an Electronic Health Record (EHR) system and reach the deadline set down by the Centers for Medicare & Medicaid Services (CMS), failing which, they will begin facing reductions in their Medicare reimbursements by 2015. However, according to a new report by a federal oversight agency, while the government is putting in more than $22 billion to this venture, EHRs are increasing the incidence of medical billing fraud. The reason is that the federal government has failed to ensure adequate safeguards to prevent the technology from being used for inflating costs and over-billing. EHR Copy and Paste – Lack of Proper Guidelines The lack of proper guidelines has led to the inappropriate use of the copy and paste function in the EHR system. This has resulted in a serious compliance and payment problem. The technology allows information to be quickly copied from one document to another, the idea being to reduce the time that the physician spends on entering patient data. Also known as ‘cloning’, the EHR copy and paste function is leading to fraud and abuse of the system. Here are some of the major issues:  The EHR copy and paste technique is being illegally used to upcode patients’ medical conditions. Doctors are overcharging Medicare for the care they are providing. Government estimates say that such abuses of the EHRs are running into millions of dollars.  Another issue is that as doctors are routinely copying information from one file to another to save time, it may happen that the data they enter is not relevant or even erroneous. An article in Healthcare IT News reported on the case of a patient who had a “family history of breast cancer” wrongly entered as “a history of breast cancer”. She almost lost her coverage because the insurance company thought she had lied and it took months to track her records and get things cleared up.  There have even been cases when a physician copied the exam from one patient into another patient. According to the inspector general’s office, Medicare has failed to provide proper instructions to the contractors who actually handle the payments on how to detect
  2. 2. the fraud arising from EHR implementation. It also found that up to 75% of hospitals surveyed had no formal policy regarding the use of cloning. Efforts to Resolve Medical Billing Errors and Fraud The American Health Information Management Association, a group that focuses on improving the quality of health information, claims that cut and paste is one of the best ways to manage the documentation process. The need of the hour is to find ways to address the flaws in the EHR system. Medicare is proposing the following ways to address this cloning issue:  Creating strong standards for validating electronic health records, which ensures the proposed benefits and at the same time protects taxpayers from fraud, waste and abuse  Developing better guidelines for Medicare contractors to identify cases of fraud by closely reviewing changes to specific patient documents Experts also say that it is necessary to educate staff on the appropriate use of the copy/paste function. It can be used for copying patient regular medications, chronic allergies, demographics, problem lists and labs and treatments - if these are ongoing. Conducting internal audits could also help detect flaws so that they can be corrected promptly. Proper medical billing and coding practices are crucial to ensure accuracy in the system.