OIG: Paying Close Attention To HIPAA Security In Meaningful Use Audits

According to the recently released work plan of The Office of the Inspector General will continue to pay closer attention to the healthcare industry’s use of electronic health records – in particular HIPAA security, EHR incentive payments and fraud.

As digitization continues to be a priority so does it’s appropriate implementation and use. In a response to ensure IT security, compliance and electronic health records, the OIG has requested a $400 million FY2015 budget, an increase of $105 million and creating another 284 fulltime jobs to enforce the OIGs audits and reviews.

“Important changes are taking place across the healthcare industry,” wrote Daniel R. Levinson, U.S. inspector general, in OIG’s 2015 work plan justification. These changes, Levinson continued, include “an emphasis on coordinated care and an increased use of electronic health records. OIG will need to adopt oversight approaches that are suited to an increasingly sophisticated healthcare system and that are tailored to protect programs and patients from existing and new vulnerabilities.”

So how does that translate to healthcare providers and healthcare organizations? Practices can expect closer scrutiny for HIPAA privacy and security compliance. Penalties have increased significantly under the new regulations. Practices can face fines up to $50,000 per occurrence—quickly offsetting or negating the EHR incentives they received.

Physicians can no longer afford to be relaxed about HIPAA compliance. They must have sound privacy and security protocols in place to protect against violations that could result in severe penalties.

A prime example occurred in July 2009, when a physician and two former employees of an Arkansas medical center pleaded guilty to misdemeanor federal charges that they inappropriately accessed the medical records of a local television anchor, thereby violating the HIPAA privacy rule. Each faces a maximum penalty of one year in prison, a fine of up to $50,000, or both.

Meaningful Use Audits are on the Rise!

The HHS Office of Inspector General has stated the OIGs intent to review electronic health records meaningful use incentive payments and the security of electronic health records under the program in 2015. With the recent ask of a $100 million increase in budget and the addition of 284 full-time employees, this should come as a big red warning flag to those providers who either intentionally or unknowing provided inaccurate attestation information in previous years. Although the reviews have not been coined under the term “audit”, the OIG did state that, “We will review Medicare incentive payment data from 2011 to identify payments to providers that should not have received incentive payments (e.g., those not meeting selected meaningful use criteria),” according to HHS OIG’s work plan for 2015. “We will also assess CMS’s plans to oversee incentive payments for the duration of the program and corrective actions taken regarding erroneous incentive payments.” Medicaid incentive payments also will be reviewed.

The scope of the OIG reviews is not clear. A spokesperson says OIG auditors will conduct the reviews and share findings with CMS.

Although the “scope” may not be clear, what is clear is that those providers who reported erroneous data or are not prepared to provide actual data to support their meaningful use attestation and received incentive payments, will be expected to return and the incentive payments and could also be fined.

It is important to hire an expert in Meaningful Use Audits to Conduct a Mock Audit to ensure your information is accurate, it may not be too late to resolve what could potentially be an issue, however once the audited or the appeals process it may take up a great deal of time.  If you would like to conduct a Mock Audit or facing a  Meaningful Use Audit or Appeal Be contact EHR & Practice Management Consultants, Inc. at 1-800-376-0212 or contact@ehrpmc.com.

Former Hospital CFO Charged with Healthcare Fraud by Falsely Attesting for Meaningful Use Incentives

Eligible Professionals (EPs) and Eligible Hospitals (EHs) could easily lead to errors in meaningful use (MU) attestations. If audited these errors would turn up based on pre- and post-payment attestations and separate the knowledge gaps from willful actions.

As for looking at this case a grand jury indictment is not evidence of guilt, and all defendants are presumed innocent until proven guilty beyond a reasonable doubt in a court of law.” For the details of the indictment we have the FBI to thank:

“Joe White, 66, of Cameron, Texas, was indicted by a federal grand jury on January 22, 2014, and charged with making false statements to the Centers for Medicare and Medicaid Services (CMS) and aggravated identity theft.”

“According to the indictment, on November 20, 2012, White falsely attested to CMS that Shelby Regional Medical Center (Shelby Regional) met the meaningful use requirements for the 2012 fiscal year. However, Shelby Regional relied on paper records throughout the fiscal year and only minimally used electronic health records. To give the false appearance that the hospital was actually using Certified Electronic Health Record Technology, White directed its software vendor and hospital employees to manually input data from paper records into the electronic health record (EHR) software, often months after the patient was discharged and after the end of the fiscal year.”

“The indictment further alleges that White falsely attested to the hospital’s meaningful use by using another person’s name and information without that individual’s consent or authorization. As a result of the false attestation, CMS paid Shelby Regional $785,655. In total, hospitals operated by Dr. Mahmood, including Shelby Regional, were paid $16,794,462.66 by the Medicaid and Medicare EHR incentive programs for fiscal years 2011 and 2012.”

“If convicted, White faces up to five years in federal prison for making a false statement and up to two years in federal prison for aggravated identity theft.”

As more and more federal stimulus money is made available to providers to adopt Electronic Health Record systems and meaningfully use them our firm is expecting to see many more cases like this case.

If you need help with a Meaningful Use Audit, Meaningful Use Appeal,  Mock Audit or Have Questions on Attesting for Meaningful Use we would be happy to help you to avoid these pitfalls.  Feel free to contact Vanessa Bisceglie MBA, B.S. with EHR & Practice Management Consultants, Inc.  at 800-376-0212 or email her at vanessa.bisceglie@ehrpmc.com.

Important Items You Need To Know In 2014 If You Are Eligible To Participate in the Meaningful Use Incentive Programs:

Important Items You Need To Know In 2014 If You Are Eligible To Participate in the Meaningful Use Incentive Programs:

1.  You need to upgrade to the 2014 Edition Certified EHR software.

2.  Make sure your EHR vendor will meet the 2014 certification criteria.

3.  In 2014 a special change has been made, only an EP can attest for any 90 day continuous period, regardless, if you have attested in the past to accommodate providers whose EHRs are not yet 2014 certified. EPs last date of the reporting period is October 1, 2014 to attest for 2014.

4.  For providers participating in the Medicare EHR Incentive Program 2014 is the last year to participate in the Medicare EHR Incentive Program

5.  If you do not attest by 2014 for Meaningful Use you will receive a payment adjustment to Medicare reimbursements starting January 1, 2015.  The penalty is 1% the first year and will go up incrementally each year to a maximum of 5%.

  • A provider can register for the Meaningful Use program in 2015 but they will not receive an incentive payment.
  • If 2014 is your first year to attest you can still qualify for $24,000 in incentive payments over a 3 year period.
  • Meaningful Use Stage 1 Objectives will change in 2014.  Please see the tipsheet from CMS
Meaningful Use Attestation Clinical Quality Measure
 Requirements Requirements
EPs EH/ CAHs EPs EH/ CAHs
Core Menu Core Menu
2011 Stage 1 15 5 out of 10 14 5 out of 10 Report on 6 Report on 15
2014 Stage 1 13 5 out of 9 11 5 out of 10 Report on 16 that cover at least 3 out of 6 National Quality Strategy Domains Report on 16 that cover at least 3 out of 6 National Quality Strategy Domains

7. Meaningful Use Audits are to be conducted for both pre-payment and post-payment in up to 10% EPs audited each year.6. EPs can no longer claim an exclusion on a menu objective if there are other menu objectives they can meet.

8. Stage 2 will be extended through 2016 and Stage 3 will begin in 2017 for those providers who have completed at least 2 years in Stage 2.  Therefore, a provider could potentially attest in Stage 2 for 3 years instead of 2 years.

STAGES OF MEANINGFUL USE
1st YEAR

2011

2012

2013

2014

2015

2016

2017

2018

2019

2020

2021

2011

1

1

1

2

2

2

3

3

TBD

TBD

TBD

2012

1

1

2

2

2

3

3

TBD

TBD

TBD

2013

1

1

2

2

3

3

TBD

TBD

TBD

2014

1

1

2

2

3

3

TBD

TBD

2015

1

1

2

2

3

3

TBD

2016

1

1

2

2

3

3

2017

1

1

2

2

3

9.  Multiple systems can be used to attest to Meaningful Use

  • If you are unhappy with your current EHR vendors portal or your current EHR vendor does not have a portal you can choose to use an EHR independent third party patient portal to attest to Meaningful Use, as long as both systems have 2014 Edition certification.
  • Additionally, talk to both your EHR vendor and patient portal vendor to make sure they will interface.

10. The transitions of care measure in Stage 2 requires providers to “conduct one or more successful electronic exchanges of a summary of care document, with a recipient who has EHR technology designed by a different EHR technology developer than the sender’s,” or “conduct one or more successful tests with the CMS designated test EHR during the EHR reporting period.” CMS now has designated McKesson and Meditech as the first two “Test EHRs,” and seeks more.

11. If you are only eligible to participate in the Medicaid EHR Incentive Program, you are not subject to these payment adjustments.

If you have any questions regarding Meaningful Use or need help with attesting in 2014 feel free to contact me and our team will be happy to help you attest!

Vanessa Bisceglie M.B.A, B.S.,  President,  EHR & Practice Management Consultants, Inc.   www.ehrpmc.com  800-376-0212  847-322-0139