Implementing EHR in hospitals has increased the rate of medical billing error and fraud. Medicare is taking strong measures to address these issues.

1. EHR Adoption Leading to Increasing Incidence of Medical Billing Fraud
Healthcare providers are racing ahead to implement Meaningful Use of an Electronic
Health Record (EHR) system and reach the deadline set down by the Centers for
Medicare & Medicaid Services (CMS), failing which, they will begin facing reductions
in their Medicare reimbursements by 2015. However, according to a new report by a
federal oversight agency, while the government is putting in more than $22 billion to
this venture, EHRs are increasing the incidence of medical billing fraud. The reason is
that the federal government has failed to ensure adequate safeguards to prevent the
technology from being used for inflating costs and over-billing.
EHR Copy and Paste – Lack of Proper Guidelines
The lack of proper guidelines has led to the inappropriate use of the copy and paste
function in the EHR system. This has resulted in a serious compliance and payment
problem. The technology allows information to be quickly copied from one document
to another, the idea being to reduce the time that the physician spends on entering
patient data. Also known as ‘cloning’, the EHR copy and paste function is leading to
fraud and abuse of the system. Here are some of the major issues:

The EHR copy and paste technique is being illegally used to upcode patients’
medical conditions. Doctors are overcharging Medicare for the care they are
providing. Government estimates say that such abuses of the EHRs are
running into millions of dollars.

Another issue is that as doctors are routinely copying information from one
file to another to save time, it may happen that the data they enter is not
relevant or even erroneous. An article in Healthcare IT News reported on the
case of a patient who had a “family history of breast cancer” wrongly entered
as “a history of breast cancer”. She almost lost her coverage because the
insurance company thought she had lied and it took months to track her
records and get things cleared up.

There have even been cases when a physician copied the exam from one
patient into another patient.
According to the inspector general’s office, Medicare has failed to provide proper
instructions to the contractors who actually handle the payments on how to detect

2. the fraud arising from EHR implementation. It also found that up to 75% of hospitals
surveyed had no formal policy regarding the use of cloning.
Efforts to Resolve Medical Billing Errors and Fraud
The American Health Information Management Association, a group that focuses on
improving the quality of health information, claims that cut and paste is one of the
best ways to manage the documentation process. The need of the hour is to find
ways to address the flaws in the EHR system. Medicare is proposing the following
ways to address this cloning issue:

Creating strong standards for validating electronic health records, which
ensures the proposed benefits and at the same time protects taxpayers from
fraud, waste and abuse

Developing better guidelines for Medicare contractors to identify cases of
fraud by closely reviewing changes to specific patient documents
Experts also say that it is necessary to educate staff on the appropriate use of the
copy/paste function. It can be used for copying patient regular medications, chronic
allergies, demographics, problem lists and labs and treatments - if these are
ongoing. Conducting internal audits could also help detect flaws so that they can be
corrected promptly. Proper medical billing and coding practices are crucial to
ensure accuracy in the system.