Medicaid Doctors and Dentists Gaming the EHR Incentive Program

I guess I should have known that it would only be a matter of time before I’d see something like this come out. As best I can tell, Dentrix has partnered with Henry Schein to offer what they’re calling Dentrix Meaningful Use Access 7.6. Seems like Henry Schein is using the Dentrix names to get Dentists access to the Medicaid EHR incentive money. On face, I don’t see any problem with this.

Although, once you start to dig into it, it appears that Dentrix and Henry Schein are partnering to get Dentists the first Medicaid EHR incentive check without even implementing the EHR. You have to remember that the Medicaid EHR stimulus money doesn’t require you to show meaningful use of the EHR. You just have to acquire the EHR technology.

Look at some of the verbiage from the website for the program:

Definition of Adopt, Implement, or Upgrade:
For Medicaid, the eligible provider must Adopt, Implement, or Upgrade (AIU) certified EHR software. As posted on the CMS website, for AIU, a provider does not have to have installed certified EHR technology. The definition of AIU in 42 CFR 495.302 allows the provider to demonstrate AIU through any of the following:
*Acquiring, purchasing or securing access to certified EHR technology
*Installing or commencing utilization of certified EHR technology capable of meeting meaningful use requirements
or
*Expanding the available functionality of certified EHR technology capable of meeting meaningful use requirements at the practice site, including staffing, maintenance, and training, or upgrade from existing EHR technology to certified EHR technology per the ONC EHR certification criteria.

Thus, a signed contract indicating that the provider has adopted or upgraded would be sufficient.

To be honest, I’m torn between whether this is genius or filthy. According to the letter of the law, I don’t know of any reason that someone with the right Medicaid population can’t purchase an EHR like this for $2000 and then collect the EHR incentive money. The regulations don’t require them to do any more to collect the money. Although, that’s certainly not the intent of the EHR incentive money and definitely feels like their gaming the system if they do it with no intent to actually implement the EHR.

Another piece from the website:

While Henry Schein currently has no plans to pursue a Meaningful Use solution beyond Stage 1, Year 1 for Dentrix, we continue to monitor healthcare reform to determine what subsequent steps, if any, should be taken regarding Meaningful Use criteria and certification.

At least their up front with the Dentists that they’re not planning to go beyond meaningful use stage 1, but may change their minds. I’m sure this is music to ONC’s ears to hear that they’re only committing to meaningful use stage 1.

If your strategy is to just help these dentists get the first EHR incentive check, then why should you worry about MU stage 2. Wouldn’t you love to be a salesperson for this product? Here’s your pitch: Pay me $2000 for this EHR, go through 5 steps on the government website and you’ll get paid $21,250.00.

I wish I could see something legally wrong with this idea. Someone I talked to mentioned that even for the Medicaid EHR incentive money you have to check some box saying that you comply with the HIPAA requirements. Well, these clinics have to do that anyway. Many don’t, but they’ll check that box anyway thinking that they comply whether they do or not.

The biggest surprise for me might be that Henry Schein is willing to have their name associated with a program like this. I’ll be interested to see who else picks up on this glaring issue with the Medicaid EHR incentive and what ONC/CMS/HHS do to close it up (if they can).

About the author

John Lynn

John Lynn

John Lynn is the Founder of the HealthcareScene.com, a network of leading Healthcare IT resources. The flagship blog, Healthcare IT Today, contains over 13,000 articles with over half of the articles written by John. These EMR and Healthcare IT related articles have been viewed over 20 million times.

John manages Healthcare IT Central, the leading career Health IT job board. He also organizes the first of its kind conference and community focused on healthcare marketing, Healthcare and IT Marketing Conference, and a healthcare IT conference, EXPO.health, focused on practical healthcare IT innovation. John is an advisor to multiple healthcare IT companies. John is highly involved in social media, and in addition to his blogs can be found on Twitter: @techguy.

13 Comments

  • The Medicaid incentive program is designed in such a way that it is susceptible to gaming, but it also can provide practitioners, including dentists, and incentive to serve an underserved population, which I believe was the original intent of the legislation.

    MacPractice DDS was the first certified dental software, since February, 2011, and it is a single, integrated dental specific solution.

    All of MacPractice products are certified: MacPractice MD, MacPractice DDS, MacPractice DC, and MacPractice 20/20, and it is our plan to to satisfy all future MU requirements in order to receive updated certifications.

    Mark Hollis, CEO
    http://www.MacPractice.com
    MarkHollis@MacPractice.com

  • I have not heard that those who do not apply in the second year are the most likely to be audited. My understanding is that it is possible for a provider to skip a year, and it is not at all impossible that there will be those who feel the need to do so, as the second year requires a full year of MU, and a botched EHR implementation or a major or minor vendor that goes belly up or is acquired could create a need to delay.

    Qualifications for Medicaid incentives in the 1st year are very low. Any provider who applied and did not in fact meet those qualifications…

    Personally as a taxpayer, I think CMS should at least randomly audit. After all, the incentives come from taxpayer pockets.

    Mark Hollis, CEO
    MacPractice, Inc.

  • Meaningful Use attestation is similar to filling out taxes. There is a small chance that you will get audited, but it is up to you whether or not you want to take the risk. Personally, I believe medical and dental professionals should hold themselves to a higher standard, and I am sure that this higher standard is what CMS expects with regard to the incentives for Meaningful Use.

  • I can see it now. You sign up for a free EHR, and then go for the MU money. Personally, I would consider that a bit abusive.

  • Dentrix and Easy Dental seem to facilitate some of this “Gaming” by design. The Dental practice purchases a $1900 CD that allows them to “meet MU” but I am yet to see one loaded successfully. The dentists are so intertwined with these folks at Henry Schein for many other business needs; equipment, etc, etc. that most give up or drop out of the MU process post AIU. The Henry Schein site does an excellent job of providing information on MU aligning and referring everyone to CMS site for info but seems to successfully avoid mentioning specifically how their CHPL technology allows anyone to meet MU now or in the future. Regardless of how you feel about MU this really falls on the “filthy” side of the issue as far as I am concerned.

  • That’s really crazy. I thought they’d at least offer a working product. I didn’t think they’d offer something that was vaporware. Your point about the dentists being so connected to Henry Schein for other things is a really interesting one. That does make it difficult.

  • I can’t remember the exact number, but it won’t catch people employing the scheme above because it’s not illegal. At least from what I can tell, and I’m sure Henry Schein’s lawyers are good at what they do.

  • By the way, MacPractice is continuing to develop MacPractice DDS for MU Stage 2 Certification projected for October 2013.

    Our DDS users who may require ICD-10 capability in October next year will have that as well. Some dentists and dental specialties submit both dental and medical claims.

    I would like to re-emphasize that MacPractice DDS and MacPractice EDR are specific to dentistry and are a single integrated application versus a dental software interfaced with a certified medical EHR application developed by an entirely different development team, with both products having entirely different user interfaces.

    We are working with a couple of RECs and a state Medicaid office to help some of our dentists who received the first Medicaid incentive to be the first dentists to demonstrate MU Stage 1 this year.

    Mark Hollis
    MacPractice, Inc. CEO

  • Mark,
    Are there a lot of dentists that are looking at MU? Most that I’ve talked to have no idea what it is and those that do don’t want to touch it with a long stick.

  • John,

    The ADA says that 14% of dentists bill Medicaid. There are 155,000 dentists, so in theory that is 21,700 who might be eligible for Medicaid incentives. Pediatric dentists who accept Medicaid represent a large percentage of those dentists who are eligible to participate.
    Oral surgeons bill Medicare, and there are about 8000 of them. Other dental specialists bill Medicare for sleep apnea, TMJ and some other procedures.
    There Community Health Centers that offer dental services. I have been told that they are finding that they cannot demonstrate MU with the software they have, and will not receive incentives after the first year.

    Dentists tend to be very philanthropic, and there are numerous dental nfp’s that offer services to the needy.

    To answer your question, not a large number of those that are eligible inquire about the incentives. And you are also correct that many providers do not want to invite an auditor into their practice. But I believe that the ADA and dental specialty associations have not to date done a great job of evangelizing to their members. One of the few articles I have seen from the ADA had several inaccuracies in its description of the program that have yet to be corrected after a request was made. Anonther article did not list MacPractice DDS as an option, although MacPractice was the first option in dentistry to attain certification.

    There are many underserved US citizens including many children who could benefit from dental services provided by dentists who receive the incentives, which were intended for that purpose, and it is MacPractice’s mission to educate and evangelize the true potential of the program.

    Mark Hollis
    CEO, MacPractice, Inc.

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