HMT: EHR Fraud detection Inadequate, Rural meaningful use, flaws in digitizing patient records, and more
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January 10, 2014
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In this issue:

OIG: EHR fraud detection inadequate

Meaningful Use outside of the metropolis: the challenges of rural health IT adoption

Report finds more flaws in digitizing patient files

Google X staff meet with FDA pointing to possible medical device

Samsung: Galaxy S5 out by April, may scan your eyes

OIG: EHR fraud detection inadequate

The Centers for Medicare and Medicaid Services and many of its contractors need to adopt better practices to detect fraud committed using electronic health records, according to a new government watchdog report.

Although EHR technology may make it easier to perpetrate fraud, CMS and its contractors have not adjusted their practices for identifying and investigating fraud committed using EHRs, says the new report from the Department of Health and Human Services' Office of Inspector General.

Another OIG report released in December found that EHRs make it easier for healthcare providers to commit fraud. That report noted that healthcare fraud of all kinds totals $75 billion to $250 billion a year (see Insights on Detecting Healthcare Fraud).

Last month's report also highlighted the need for hospitals to make broader use of the audit log function within EHRs to help detect fraud.

New Report's Findings

The OIG report released this week was based on an online survey conducted in January 2013 of nearly 20 CMS administrative and program integrity contractors that use EHRs to pay claims, identify improper Medicare payments and investigate fraud.

For its report, OIG also reviewed guidance documents and policies on EHRs and fraud vulnerabilities that CMS and its contractors released for healthcare providers. Additionally, the watchdog agency reviewed CMS transmittals of new or changed policies and procedures relating to EHRs.

Overall, OIG found that CMS and its contractors had adopted few program integrity practices specific to EHRs.

More specifically, few contractors were reviewing EHRs differently from paper medical records, the OIG found. In addition, not all contractors reported being able to determine whether a healthcare provider had used the EHR cut-and-paste feature to falsify records or had over-documented a medical record by inserting false or irrelevant digitized documentation to create the appearance of support for billing higher level services.

Finally, OIG found that CMS had provided limited guidance to Medicare contractors on EHR fraud vulnerabilities.

Two Recommendations

OIG recommends that CMS provide guidance to its contractors on detecting fraud associated with EHRs. It suggests CMS work with contractors to identify best practices and develop guidance and tools for detecting fraud associated with EHRs.

OIG also recommends that CMS direct its contractors to use providers' audit log data to distinguish EHRs from paper medical records, providing a "valuable" tool to CMS's contractors when reviewing medical records.

Read the full Healthcare Info Security article here

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Meaningful Use outside of the metropolis: the challenges of rural health IT adoption

Rural hospitals face numerous challenges in the realm of health IT adoption. However, thanks to a helping hand from the federal government and other organizations, they're making progress.

Michael Archlueta is more than just the director of IT of Mt. San Rafael Hospital, a 25 bed critical-access hospital in Trinidad, Colo. Essentially, he serves as the individual responsible for a never-ending list of responsibilities, which would normally be dispersed unto many individuals within the IT department.

"At times, I've faced difficulty in regards to having limited resources made available to me," he says. "The challenge has been the tremendous work-load that I’m juggling and expectations that I’m continuously striving but successfully overcoming all obstacles."

In a community of about 9,000 people in rural Colorado, he says it's "extremely difficult" to recruit individuals that have the required health IT background. And that's not the only challenge rural hospitals face. Implementing an electronic health record system isn't very affordable, and the pressure is on for rural hospitals to turn the increasingly large sums they have spent into a worthwhile investment that will eventually improve quality, safety and efficiencies; reduce health disparities; engage patients and their families; and improve care coordination and population and public health, all while maintaining the privacy and security of patient health information, Mr. Archuleta says.

"In order to become fully successful in implementing an EHR, while also meeting meaningful use, we all need to work together toward the common goal at hand, as a team," he says. "We need to make sure that we complete these tasks in a timely manner, while remaining as efficient as possible and most importantly we must provide the best patient care for our community."

Mt. San Rafael is not alone in facing these obstacles to implement a successful health IT adoption. According to the Office of the National Coordinator for Health IT, CAHs and other small, rural hospitals — which serve the approximately 60 million Americans residing in rural communities — can face hurdles when it comes to funding, personnel and other resources needed to implement EHRs and other forms of health IT.

However, the situation isn't as grim as it might seem for rural providers. The ONC and other organizations such as the Health Resources and Services Administration's Office of Rural Health Policy have provided resources and launched efforts to keep smaller, rural hospitals from falling behind in health IT.

"My mandate is to make sure that rural communities and rural healthcare providers aren't left behind in the push to leverage technology in healthcare," says Leila Samy, the ONC's rural health IT coordinator. "These rural safety net hospitals are anchor institutions. They are often the largest or second largest employers in their communities. Health IT in these rural communities is really a tremendous opportunity to fuel economic development."

The challenges: Lack of resources, funding stand in the way of IT adoption

All hospitals and health systems — not just rural ones — face significant incentives to adopt health IT, especially EHRs. The American Recovery and Reinvestment Act of 2009 authorized CMS to award incentive payments to eligible healthcare professionals and hospitals that demonstrate meaningful use of EHRs.

Through the Medicare and Medicaid EHR Incentive Programs, eligible hospitals, including CAHs, can earn $2 million or more, according to the ONC. At the same time, Medicare and Medicaid providers that don't adopt EHRs will face financial penalties starting in 2015.

Demonstrating meaningful use involves using certified EHR technology to improve quality, safety and efficiencies and reduce health disparities; engage patients and their families; and improve care coordination and population and public health, all while maintaining the privacy and security of patient health information. The scheduled meaningful use objectives will be implemented in three stages involving first capturing and sharing data, then advancing clinical processes and, finally, showing improved outcomes. Attestation for both incentive programs began in 2011.

Read the full Becker’s Hospital Review article here

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Report finds more flaws in digitizing patient files

Although the federal government is spending more than $22 billion to encourage hospitals and doctors to adopt electronic health records, it has failed to put safeguards in place to prevent the technology from being used for inflating costs and overbilling, according to a new report by a federal oversight agency.

The report, released on Wednesday by the Office of the Inspector General for the Health and Human Services Department, is the second in two months to warn about flaws in the oversight of the ambitious federal program aimed at converting patient records from paper to electronic. It comes as the Obama administration continues to face broad criticism over the troubled rollout of its health care law — especially the site.

Despite spending “considerable resources to promote widespread adoption of E.H.R.’s,” or electronic health records, the government has “directed less attention to addressing potential fraud and abuse,” according to the report. Medicare has not changed the way it tries to detect fraud and has provided its contractors “with limited guidance,” the report said.

The report was especially critical of the lack of guidelines around the widely used copy-and-paste function, also known as cloning, available in many of the largest electronic health record systems. The technique, which allows information to be quickly copied from one document to another, can reduce the time a doctor spends inputting patient data. But it can also be used to indicate more extensive — and expensive — patient exams or treatment than actually occurred. The result, some critics say, is that hospitals and doctors are overcharging Medicare for the care they are providing. While the report did not estimate the amount of fraud that may be occurring, earlier government estimates have said it could run in the hundreds of millions of dollars. Although the amount is a fraction of the trillions of dollars spent annually on health care, the lack of safeguards at a time when the new technology is becoming pervasive could allow the fraud to balloon.

“As E.H.R. adoption has increased, so has its involvement in our cases,” said Michael Cohen, an inspector at the oversight agency’s investigations office, which is charged with investigating health care fraud in government programs.

Read the full New York Times article here

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Google X staff meet with FDA pointing to possible medical device

Google Inc. sent employees with ties to its secretive X research group to meet with U.S. regulators who oversee medical devices, raising the possibility of a new product that may involve biosensors from the unit that developed computerized glasses.

The meeting included at least four Google workers, some of whom have connections with Google X -- and have done research on sensors, including contact lenses that help wearers monitor their biological data. Google staff met with those at the Food and Drug Administration who regulate eye devices and diagnostics for heart conditions, according to the agency’s public calendar.

As technology and medicine merge to give consumers more control over their health, innovators from mobile-health application developers to DNA analysis companies have struggled to meet the demands of federal oversight. The FDA ordered Google-backed 23andMe Inc. in November to halt sales of its personal gene test, saying it hadn’t gained agency approval.

Google, expanding beyond its core search-engine business, is investing in long-term projects at its X lab that may lead to new market opportunities, including the Glass devices, driverless cars and high-altitude air balloons to provide wireless Internet access. While some projects may not deliver significant profits and revenue, the company is committed to making bets on research and development, according to Chief Executive Officer Larry Page.

“Our main job is to figure out how to obviously invest more to achieve greater outcomes for the world, for the company,” Page said during a call with analysts last July. “And I think those opportunities are clearly there.”

Read the full Bloomberg Businessweek article here

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Samsung: Galaxy S5 out by April, may scan your eyes

Samsung's Galaxy S5, the next generation of its flagship smartphone, will be released by April and may include innovative eye-scanning technology.

An executive for the Korean tech giant confirmed to Bloomberg that the phone will hit stores this year on roughly the same time table as previous iterations of the device, which has emerged as the chief rival to Apple's iPhone.

The Galaxy S4 was announced last March and released in April.

Lee Young Hee, executive vice president for Samsung's mobile business, also told the news service that a new version of the company's Galaxy Gear smartwatch will be released at the same time as the new phone.

"We've been announcing our first flagship model in the first half of each year, around March and April, and we are still targeting for release around that time," Lee said. "When we release our S5 device, you can also expect a Gear successor with more advanced functions, and the bulky design will also be improved."

Speaking at the International Consumer Electronics Show in Las Vegas, Lee wouldn't say whether the eye scanner -- presumably an effort to one-up Apple's iPhone 5S with its fingerprint security feature -- is a sure thing.

"Many people are fanatical about iris recognition technology," she said. "We are studying the possibility but can't really say whether we will have it or not on the S5."

She did say the S5 will look and feel significantly different than its predecessor, which some felt wasn't different enough from the Galaxy S3.

"When we moved to S4 from S3, it's partly true that consumers couldn't really feel much difference between the two products from the physical perspective, so the market reaction wasn't as big," she said. "For the S5, we will go back to the basics. Mostly, it's about the display and the feel of the cover."

Read the full CNN article here

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