WASHINGTON DC (February 8, 2019) — Senate Finance Committee Chairman Chuck Grassley continued his inquiry into inappropriate payments made by the Centers for Medicare and Medicaid Services (CMS) to professionals within the electronic health records (EHR) program after a 2017 watchdog report indicated the payments could amount to more than $700 million.
In a letter to CMS Administration Seema Verma, Grassley sought information on what progress has been made to recoup taxpayer dollars lost to these improper payments and how many instances of improper payments CMS has found in the course of its random audit process.
“The actual and potential financial loss to the taxpayer is staggering. I urge CMS to take all reasonable steps to ensure that taxpayer money is properly used and recovered within the EHR program,” Grassley wrote.
The improper payments were made under the Electronic Health Records Incentive Program to professionals that should have met the “meaningful use” requirement under that program.
Grassley’s letter follows up on correspondence from 2017, when former Finance Committee Chairman Orrin Hatch and Grassley jointly wrote to Verma about these payments. Verma responded two months later with initial answers to their questions.
This week, the Justice Department also made an announcement relating to the EHR Incentive Program: an EHR vendor agreed to pay $57.25 million dollars to settle False Claims Act allegations. Grassley authored the 1986 amendments to the False Claims Act, which have led to the recovery of over $59 billion lost to fraud.
Full text of Grassley’s letter to Verma follows or can be found HERE.
February 4, 2019
VIA ELECTRONIC TRANSMISSION
The Honorable Seema Verma
Administrator
Centers for Medicare & Medicaid Services
200 Independence Ave, SW
Washington DC 20201
Dear Administrator Verma,
On July 12, 2017, I wrote to you regarding the Medicare Electronic Health Record (EHR) Incentive Program.[1] That program was established to improve healthcare quality, safety, and efficiency through the adoption of EHR technology. EHR’s allow providers complete information on which to base a diagnosis or treatment plan as well as the ability to share patient information with hospitals, pharmacies, and laboratories. In my letter, I noted that the U.S. Department of Health and Human Services, Office of Inspector General (HHS OIG) reported that Medicare may have paid hundreds of millions in electronic incentive payments that did not meet the “meaningful use” requirement under the EHR Incentive Program.
On September 26, 2017, the Centers for Medicare & Medicaid Services (CMS) responded that it conducts random pre-payment and post-payment audits to determine whether professionals are appropriately receiving incentive payments and, as a result, had identified improper payments.[2] Specifically, CMS stated that it received the necessary data to “validate the suspected $291,222 in overpayments made to 14 sampled professionals…” and is working to recoup those costs.[3] Based on CMS’ data, the HHS OIG estimated that CMS paid $729,424,395 to individuals that should not have received it.[4] CMS’ response also noted that, as of September 12, 2017, it had recovered $2,143,223 in overpayments made to professionals who switched between Medicare and Medicaid and improperly received payments from both programs of which $201,457 remained outstanding.[5] The actual and potential financial loss to the taxpayer is staggering. I urge CMS to take all reasonable steps to ensure that taxpayer money is properly used and recovered within the EHR program.
Accordingly, please answer the following no later than February 19, 2019:
1. In the past five years, how many random audits of eligible professionals did CMS conduct? How many received improper payments?
2. Please describe, in detail, the steps CMS took to recoup payments from professionals that received improper EHR payments.
3. How many audits resulted in a referral to the Center for Program Integrity?
4. With respect to the HHS OIG’s finding that CMS may have inappropriately paid $729,424,395, what steps has CMS taken to recover that amount?
5. With respect to the $291,222 in overpayments made to the 14 sampled professionals, how much has been recovered?
6. With respect to the remaining $201,457 in improper payments that were made to professionals who switched between Medicare and Medicaid within the same year, how much has CMS recovered?
7. From 2015 to 2018, eligible professionals who did not successfully demonstrate meaningful use were subject to a downward adjustment to their Medicare physician fee schedule payments. How many eligible professionals were subject to a payment adjustment in those years, and what was the total amount of the adjustment?
Thank you for your attention to these important matters. Should you have questions, please contact Josh Flynn-Brown or Caitlin Soto of my Committee staff at 202-224-4515.
Sincerely,
Charles E Grassley
Chairman
Committee on Finance
