CMS and Its Contractors Have Adopted Few Program Integrity Practices to Address Vulnerabilities in EHRs.

摘要

Electronic health records (EHRs) replace traditional paper medical records with computerized recordkeeping to document and store patient health information. Experts in health information technology caution that EHR technology can make it easier to commit fraud. For example, certain EHR technology features may be used to mask true authorship of the medical record and distort information to inflate health care claims. The transition from paper records to EHRs may present new vulnerabilities and require the Centers for Medicare & Medicaid Services (CMS) and its contractors to adjust their techniques for identifying improper payments and investigating fraud. We sent an online questionnaire to CMS administrative and program integrity contractors that use EHRs to pay claims, identify improper Medicare payments, and investigate fraud. We also reviewed guidance documents and policies on EHRs and fraud vulnerabilities that CMS and its contractors released for health care providers. Lastly, we reviewed documents on EHRs and Medicare claims that CMS provided to its contractors.