Meaningful Use Audits are increasing because the federal government has adopted a pay and chase method of ensuring that stimulus funds for meaningful use of electronic health records were paid appropriately. The Office of the Inspector General (OIG) and Government Accountability Office (“GAO”) are reviewing CMS expenditures of $30 billion in stimulus funds.  Since the OIG and GAO cannot measure tangible benefits of electronic health records directly, they are measuring the compliance of the Meaningful Use Attestations.  The OIG has 1,700 employees dedicated to avoiding fraud, waste, and abuse.

In short, Congress cannot measure the value of $30 billion in stimulus dollars but they can audit your attestation.  Audits are examined based on a point in the past.  You cannot remediate the past.

If your organization is found deficient in a Final Determination at the end of an audit, you will immediately owe 100% of the stimulus funds back to CMS.

If your organization is found to be negligent, where there was willful avoidance of the facts or concealment, you or your company could be subject to treble damages (source: Managing Partner specializing in health care law, leading law firm).  Therefore Meaningful Use compliance and audit risk are board–level issues.

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Inpatient and outpatient audit defense for final determinations, remediation steps, recommendations
Inpatient and outpatient audit defense for final determinations, remediation steps recommendations

It is not surprising then that this organization has determined that severe penalties liability may be one of the consequences for failing to provide adequate documentation of proof that on the date of a Meaningful Use attestation, and for up to six years thereafter, Eligible Providers must keep records of their attestation documentation.  Figliozzi and Company who is currently CMS’s agent for audits,  is a Medicare contractor servicing the federal government and Medicare Administrative Contractors (MAC) throughout the country. They specialize in the audits of healthcare facilities to determine compliance with Medicare and Medicaid regulations.

If even one measure is not documented, a healthcare provider can fail their audit. Upon failing an audit, CMS immediately sends a bill for return of all stimulus funds to the provider which is immediately due and payable, even if the provider intends to appeal.  Additional penalties may be levied.  Therefore if you suspect that your organization may be deficient, the best course of action is to be proactive in a self-evaluation and report any findings to CMS before you are audited.

It is not surprising that health care providers are failing audits. The regulatory content is deep and complex and there are multiple data points to comprehend to fully understand the breadth of Meaningful Use.
Therefore there is a higher probability than one might suspect of failure to fully comply with a MU audit.

Providers must prove the related Core Measures of Meaningful Use  were turned on (for example drug formulary interaction) – if you didn’t provide proof that something was enabled in the past, you can fail an audit (date and time stamp, physician user, etc. must be provided).

Contact us for a confidential consultation and proposal.

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