January 18, 2014

EHR Flawed and Open to Fraud

I am not concerned which name you use for medical records, but the opportunity for fraud and misuse of our medical records is becoming part of the medical problem in rising costs. I have not seen many great articles about this problem, but the NY Times is one of the better articles. The other problem I am seeing very little about is the electronic theft of many medical records from doctors' offices and hospitals.

The federal government is spending more than $22 billion to encourage hospitals and doctors to adopt electronic health records (EHRs). You would think that with this money would come some safeguards to prevent inflating costs and over billing. This is the second report issued in two months by the Office of the Inspector General (OIG) for the Health and Human Services Department, but to date, no one shows any concern.

According to the report, the government has directed very little attention to prevent fraud and other abuses of EHRs. Medicare has not changed how it detects fraud and has provided its contractors with limited guidance. The OIG report was critical of the copy and paste function available in many of the largest electronic health record systems. The result, some critics say, is that hospitals and doctors are overcharging Medicare for the care they are providing. The report did not estimate the amount of fraud that may be occurring, but earlier government estimates have said it could run in the hundreds of millions of dollars. Although the amount is a fraction of the trillions of dollars spent annually on health care, the lack of safeguards at a time when the new technology is becoming pervasive could allow the fraud to balloon.

In the prior report, the OIG found that three-quarters of the hospitals it surveyed had no formal policy for the use of copy and paste for electronic records. Of course, Medicare officials said preventing fraud is a top priority. This has been a statement that has been overused year after year and fraud continues. We always hear about it when a big fraud case is stopped, but we seldom hear about other fraud being stopped much less prevented.

I am not reassured by their statement that they are developing better instructions for their contractors. Then they dispute the OIG recommendation about how contractors should detect fraud. Apparently, if as hospital says it has something in place, the hospital should not be inspected. I say this is when inspection becomes necessary as they are probably hiding something. From my short stint as an auditor, I know this was generally true.

I find the statement by Linda E. Fishman, a senior executive for public policy at the American Hospital Association even more suspicious. When she says, “Hospitals already have strong safeguards,” she is just attempting to close the door when the horses have already gone.

The one statement I do believe is this by Dr. Ashish K. Jha, professor of health policy at the Harvard School of Public Health, who states, “As much as electronic records have the potential to provide better care, many are disappointed in the current technology. The boosters of electronic health records spent a lot of years overhyping and overselling it.”

Please read the NY Times article.

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