Adoption of EHR technologies has greatly increased as the result of the EHR Incentive Program. Touted as one of the necessary building blocks for creating integrated delivery systems, EHR is considered vital to improve health quality, efficiency and patient safety.  The EHR Incentive Program has been very successful and CMS has awarded over $10 billion dollars in incentive payments. As CMS increases payments, they also increase audits.

CMS conducts pre- and post-payment audits. CMS has no plans to slow the pace of post payment audits and is conducting pre-payment audits beginning with attestations submitted during and after January 2013. The pre-payment audits include random audits and targeted audits that look into suspicious or anomalous data.

CMS contracted with Figliozzo and Company to conduct post-payment audits. Once a provider is selected for a post-payment audit, they are contacted via email. The initial email will include a request letter from Figliozzo and Company, but it will come from a CMS email address. The audit letter will look similar to the sample letter posted on CMS’s website. This communication will be sent to the Provider’s email that was provided during initial registration with the program.

Providers have only two weeks to submit documents requested in the letter to Figliozzo and Company. CMS states that it will primarily be requesting source documents that the provider used in the attestation. Additional information may be requested during or after the initial review process. Figliozzo and Company may also request an on-site review including a demonstration of the EHR system.

Our Insight.  Your Advantage.  Failure to submit sufficient documentation can create significant liability for providers. CMS may recoup the entire incentive payment, place withholds on the provider, or the provider may be found to have made a false attestation.  If the latter occurs, the provider may be subject to criminal and civil penalties.  Because there is a short turn-around time for document submission and high costs for failure to document attestations, Providers who receive a letter from Figliozzo and Company should immediately contact counsel and begin gathering documentation responsive to the audit letter.