Obama Administration Seeks Investigation Into Billing Fraud due to EHRs

Dr. Farzad Mostashari, national coordinator for health IT, requested an investigation to see if an ordinary copy-and-paste feature in electronic health records is causing overbilling to Medicare.

Dr. Farzad Mostashari, the national coordinator for health IT in the Obama administration, is requesting a study to see if overbilling is occurring due to a cut-and-paste feature standard in all software, including electronic health record (EHR) applications.

In an interview with the Center for Public Integrity on Oct. 15, a nonpartisan investigative journalism organization, the federal health IT czar said that the Health IT Policy Committee will investigate the overbilling issue.

Committee members include experts in government, academia and health care organizations. Some are appointed by the president and others by members of Congress, the Secretary of Health and Human Services, and the acting comptroller general.

The federal government is investing $27 billion to get providers to adopt EHRs, which can enable better care collaboration and help doctors keep track of patients' chronic diseases and reduce health care costs.

Government officials are concerned about a "cloning" feature in EHRs in which doctors cut and paste from patients' previous visits, leading to higher billing.

"If we are just copying the same information over and over, that's not good medicine," Mostashari told the Center for Public Integrity. "I've asked the policy committee to provide guidance on that."

U.S. Attorney General Eric Holder and Health and Human Services Secretary Kathleen Sebelius sent a note on Sept. 24 to hospital organizations warning against using EHRs to game the Medicaid billing system.

Holder and Sebelius raised the issue of up-coding, in which doctors are using EHRs to charge for a higher intensity of care or severity of a patient's condition without improving the level of treatment.

The Center for Public Integrity had published a "Cracking the Codes" series, in which the organization described how doctors are billing higher for treating seniors. The New York Times published a similar report Sept. 21.

Cloning, the copy-and-paste cloning function that worries government officials, is a standard note-template functionality that improves word-processing efficiency, according to Shahid Shah, CEO of IT consulting firm Netspective Communications and author of the Healthcare IT Guy blog.

"It's a reasonable functionality that many medical and nonmedical applications have," Shah told eWEEK.

Although the cloning feature sounds dangerous to the public, its copy and paste capabilities are routine for software, like in Microsoft Word, he said.

"No vendor is going to disable copy and paste," he said. "People are probably going overboard by saying the cloning function itself is fraud."

Doctors use the cloning feature to copy and paste templates for routine exams, such as a well-baby visit or annual physical, said Shah. "The note-template functionality is designed to increase the efficiency of a physician who takes notes over and over again," he said.

The templates are also used to help doctors keep track of procedures they might have otherwise forgotten to perform, Shah explained.

As doctors move away from a fee-for-service billing model and will be reimbursed for outcomes under the Accountable Care Act, or Obamacare, overbilling will be a nonissue, according to Shah.

"You won't solve fraudulent activity by not using electronic health records," Jordan Battani, managing director of CSC's Global Institute for Emerging Healthcare Practices Group, told eWEEK.

EHRs bring the benefits of improved patient outcomes, but new technology also brings negative possibilities as well, Battani noted.

"The benefits that accrue from the use of electronic health records are manifest in terms of safety and outcome, but like any other innovation, they create the potential for fraud and legal enforcement needs to be on top of that," said Battani.