HHS And DOJ Are Going To Take EHR Upcoding Seriously

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As reported in the New York times:

U.S. Warning to Hospitals on Medicare Bill Abuses
By REED ABELSON and JULIE CRESWELL
Published: September 24, 2012

Saying there are “troubling indications” of abuse in the way hospitals use electronic records to bill for Medicare and Medicaid reimbursement, the Obama administration warned on Monday that it would not tolerate what it called attempts to “game the system” and vowed to vigorously prosecute doctors and hospitals implicated in fraud.

The strongly worded letter [seen below -ed.], signed by the attorney general, Eric H. Holder Jr., and the secretary of health and human services, Kathleen Sebelius, said that “electronic health records have the potential to save money and save lives.”

But the letter continued: “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. False documentation of care is not just bad patient care; it’s illegal.”

That's a start.  I am also pleasantly surprised to see the comment about effects on patient care, an issue rarely stated by the government about adverse consequences of bad health IT.

“Obviously, we are very concerned” that the adoption of electronic health records “could lead to coding inappropriately,” an administration official said. While aggressively looking for any providers who are committing fraud, the administration will also consider whether it needs to make changes in the way it pays for care.  [I hope any "cures" are not worse than the disease - ed.]
The letter, sent to five major hospital trade associations, cited possible abuses including “cloning” of medical records, where information about one patient is repeated in other records, to inflate reimbursement.
“There are also reports that some hospitals may be using electronic health records to facilitate ‘upcoding’ of the intensity of care or severity of patients’ condition as a means to profit with no commensurate improvement in the quality of care,” the letter said. 
The letter was sent two days after a front-page article in The New York Times [and the Center for Public Integrity a few days before that; I wrote about the NYT article here, and the Center for Public Integrity's article here - ed.] detailed the ways in which the greater use of electronic records by hospitals and doctors might be contributing to a rise in Medicare billing. 

The letter signed by the Secretary of HHS and U.S. AG is below:

Page 1 (click to enlarge)

Page 2 (click to enlarge)

In my opinion, the letter also needed to go to the system designers and sellers, who have in fact facilitated upcoding and created a moral hazard as at my post on upcoding here.  In effect, the concerns seem to be primarily directed at the end users - i.e., physicians and hospitals.

Now we need the same type of wake up by the country's leadership, the executive and especially the legislative branch, to occur regarding health IT safety.

That will keep the judicial branch from having to address those issues after the fact of patient harm has occurred.

-- SS