Dec. 12—Providers that copy-and-paste electronic health record (EHR) information and delete audit logs could potentially be committing healthcare fraud, according to a recent government watchdog report.

The U.S. Department of Health and Human Services (HHS) Office of Inspector General (OIG) analyzed provider EHR use and security practices and concluded common practices may open the systems up to significant charge inflation and fraud.

As a result of an OIG survey of EHR use by 847 hospitals, the agency spelled out some of the same concerns that fueled the ongoing federal antifraud effort focused on EHRs, including simple copy-and-pasting. 

“When doctors, nurses, or other clinicians copy-paste information but fail to update it or ensure accuracy, inaccurate information may enter the patient’s medical record, and inappropriate charges may be billed to patients and third-party health care payers,” the OIG report noted. “Furthermore, inappropriate copy-pasting could facilitate attempts to inflate claims and duplicate or create fraudulent claims.”

In response to several OIG recommendations aimed at stemming possible EHR-related fraud, Marilyn Tavenner, administrator for the Centers for Medicare and Medicaid Services (CMS), highlighted possible approaches federal officials may take. For instance, CMS may update its meaningful use requirements to require providers to preserve their EHR audit logs, which can be deleted.

The OIG review followed a September 2012 letter from HHS and DOJ warning providers that inaccurate upcoding is a fraudulent practice.

“However, there are troubling indications that some providers are using this technology to game the system, possibly to obtain payments to which they are not entitled,” wrote HHS Secretary KKAthleen Sebelius and Attorney General Eric Holder. “False documentation of care is not just bad patient care; it’s illegal.”

Providers generally have responded that upcoding actually reflects more accurate and comprehensive billing that EHRs allow busy clinical settings.

The Office of the National Coordinator for Health Information Technology plans regulatory rules on appropriate use of EHRs’ audit features, and CMS audits include reviews of the accuracy of hospital EHR incentive payments. CMS plans “guidelines” on the proper use of cut-and-paste features of EHRs.

Publication Date: Thursday, December 12, 2013