Tags: medicare | upcode | pasting | records | fraudulent

Inflated Billings Tied to Expansion of Digital Medical Records

Thursday, 09 Jan 2014 07:25 AM

By Elliot Jager

The Office of the Inspector General for the Health and Human Services Department has found that "copy-pasting" of electronic medical records could be used to inflate or create fraudulent Medicare and Medicaid claims, costing taxpayers millions of dollars each year.

According to The New York Times, inflated or fraudulent billings could be occurring because of pressures from the 2009 law meant to encourage medical facilities and practitioners to use digital medical records by 2015.

According to a report issued Wednesday by the HHS inspector general, the government, which is spending $22 billion to push medical providers to move away from paper records to electronic records, has not put into place mechanisms that would stop "inappropriate copy-pasting" from being used to "upcode," or in effect add services to claims that were not provided.

Hospitals and doctors can purchase their own electronic medical records packages from private vendors. These invariably include a copy-and-paste feature. The idea is to minimize the time a doctor spends doing data entry. However, it can also lead to copying more services than were actually provided, according to the Times.

Some emergency room doctors have found themselves forced to spend more time entering medical information into computers than in providing direct care for patients, the Times noted. As a result, overburdened doctors and hospitals may have been inputting some routine billable services from old to new files to save time, even when these treatments were not actually delivered.

Michelle Dougherty, of the American Health Information Management Association, told the Times "there is the potential that there is information that is being copied that is not relevant or even erroneous" making its way into the records.

Hospitals and doctors that don't move to electronic records will see their reimbursements reduced in 2015.

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