The Potential for Health Care Fraud Involving Electronic Health Records

Medicine is always evolving. In addition to discovering new treatments and other improvements in medicine itself, the way medicine is practice has changed dramatically in recent years. One of the biggest changes is the use of health information technology including electronic health records (“EHRs”). While EHRs provide many benefits to both providers and patients, many have voiced concern about misuse. Although a lot of attention has been paid to privacy concerns, there has been less discussion about another threat: Medicare fraud using EHRs and related technology. It is a very real concern to our California health care fraud law firm and fighting EHR-fraud is part of our overall commitment to ending the fraud epidemic.

An Overview of EHRs and Their Use in California
computerhealth.jpgOn the section of the website dedicated to EHRs, The Centers for Medicare and Medicaid Services (“CMS”) website describe an EHR as “an electronic version of a patients [sic] medical history.” EHR files are maintained by the medical provider and contain a wide array of information such as vital signs, medications, patient problems, and progress notes. In addition to automating access to information and streamlining provider workflow, CMS suggests the electronic records can strengthen patient-provider relationships and reduce the frequency of medical errors.

Discussing EHRs and the general use of health information technology (“HIT”), the California Healthcare Foundation (an Oakland-based nonprofit) notes that Californians are becoming increasingly interested in accessing their health records online. In summarizing a study of HIT use in California, the group notes that 77% of Californians view EHR as a valuable tracking tool and 85% believe doctors should be able to access patient information. Physician use of EHRs in California has grown significantly from 37% in 2008 to 59% in 2013. Similarly, approximately half of hospitals reported using EHRs in 2012 versus 13% in 2007.

Government Report Cites Concerns about Health Care Fraud Using EHRs
Last month, the Office of the Inspector General for the Department of Health and Human Services issued a report on the interplay between EHRs and the problem of health care fraud. The report’s title, which also serves as its Executive Summary, provides insight into its conclusions: “CMS and its Contractors Have Adopted Few Program Integrity Practices to Address Vulnerabilities in EHRs.” Noting that health care fraud already costs anywhere from $75 billion to $250 billion, the study says that experts have expressed concern that HER technology might make it easier to commit fraud. The authors cite two specific ways EHR practices could lead to fraud: Copy-Pasting/Cloning (copying data from one patient record to another, a tool intended to make record-keeping easier, could facilitate the filing of fraudulent and/or inflated claims) and Over-documentation (inserting false or irrelevant information, which can sometimes be done with a single click, to make it appear that billing for higher level services is appropriate).

In the report’s own words, the study concluded that “Although EHR technology may make it easier to perpetrate fraud, CMS and its contractors have not adjusted their practices for identifying and investigating fraud in EHRs.” The authors noted that CMS spend over $22.5 billion on incentives to encourage EHR use, but devoted little attention to the added risk of fraud. The report recommended CMS create more guidance to allow contractors to identify fraud and direct the use of audit logs, a unique feature of EHRs, to help in the claim review process.

A Whistleblower’s Law Firm Committed to Fighting Health Care Fraud
The Internet and electronic technologies have opened up a world of opportunities. While the proper use of EHRs could be hugely beneficial and improve patient care, the risk of fraud must be considered. Our firm is dedicated to helping fight health care fraud in California by working with those who witness misdeeds to bring claims against the perpetrators. Whistleblowers can help the government and the health care system recover millions, if not billions, of dollars that can help the entire health care system and every consumer of medical care. If you believe you have witnessed fraud, call to schedule a free consultation with our California health care whistleblowers’ law firm.

See Related Blog Posts:
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Addressing Medicare Fraud

(Photo by Intel Free Press)