Fraud & Abuse with EHR … hmmmm

Keeping up with all of the information regarding EHR implementation is nearly a full time job.   Every day, hospitals acquire more smaller practices because it is becoming impossible to keep up with the regulations and being able to afford to practice.    I wondered about those able to find loop holes and ways to get by with minimal effort and capture incentives.   I find this another interesting piece of the puzzle …

If this doesn’t sum it all up, I am not sure what does!

“EHRs are also driving the industry toward charts that look remarkably similar because they’re based on templates created by the technology vendors — that includes often using the same words. And that threatens to make doctors appear to be committing fraud by the practice of record cloning, or cutting and pasting from one record to another, when they are not, in fact, acting fraudulently. Alongside the federal mandate to implement an EHR under threat of a monetary fine, that creates what Stack called “an appalling Catch-22 for physicians.

Put another way: The government mandates that doctors use an EHR, the EHR vendors’ templates can sometimes create an appearance of fraud and that, in turn, opens the door for payers to decline reimbursement or, even worse, the government to prosecute doctors for the crime.

As dire as that sounds, it’s an exception that belies the unproven perception that EHRs perpetuate fraud. “Upcoding does not necessarily equate to fraud and abuse,” said Sue Bowman, AHIMA’s senior director of coding and compliance at the same event. “This is an area where more study is needed. We really need to know the causes. Further research is needed on the fraud risk of using EHRs.”