GAO Wants To See Tougher Meaningful Use Audits

Here’s some scary news. A new report from the Government Accountability Office (GAO), the federal government’s watchdog agency, has recommended that the MU program do more to verify that providers actually qualify for incentive payments.  Given that CMS already plans to begin auditing already-certified providers after they get their incentives, we could be looking at some disasters in the making.

The GAO, which conducted a review of the first year of Meaningful Use, looked at both the Medicare and Medicaid EMR incentive programs. It analyzed Medicare MU attestation data from last year, as well as looking at the verification processes used by Medicaid programs in four states and interviewing subject matter experts.

Along the way, the study picked up some interesting data points. For example, the agency found that 80 percent of hospitals and 72 percent of eligible professionals decided not to report on at least one mandatory MU measure, a loophole allowed by the program. (Hospitals can dodge up to three measures, and professionals six, if the measures aren’t relevant to their clinical practice or patient population.)

The bottom line is that the GAO recommends that CMS increase the number of prepayment verifications it does; set up timelines which will speed the process of evaluating audit effectiveness; offer states the option of having CMS collect MU data for both Medicare and Medicaid; and (the big one) collect additional MU verification information from providers from Medicare providers seeking the MU bucks.

As it is, CMS plans to start a “post payment audit” program this year which sounds as if it could involve clawbacks of already approved moneys.  It’s hardly a new trick for CMS, which already does this already happens when our friends the Recovery Audit Contractors think you’ve made Medicare claims mistakes.

About the author

Anne Zieger

Anne Zieger

Anne Zieger is a healthcare journalist who has written about the industry for 30 years. Her work has appeared in all of the leading healthcare industry publications, and she's served as editor in chief of several healthcare B2B sites.