In an earlier blog post , I described how the Medicare and Medicaid EHR Incentive Programs (also called the Meaningful Use Program) handed out payments to medical professionals and hospitals after only minimal verification (self-attestation by those receiving the money) of program requirements. In the end, the businesses run by medical professionals and hospital groups are $40+ billion richer and patients are still without shareable electronic health records that provide meaningful use. Patients, the only people capable of verifying the delivery of shareable electronic health records, were intentionally kept out of the loop. I would now like to give a specific example of the program abuse that has and is still occurring.
Earlier this year, as I was researching for this blog, I came across the list of eligible professionals (doctors) who had received Medicare and Medicaid EHR Incentive Program payments and to my surprise, one of my doctors was listed as receiving $38,000 spread over the years 2011, 2012, and 2013 for Stage 1 Meaningful Use! This is 86% of the total $44,000 allowed per medical professional for Medicare participation. Why was I surprised? In 2014, when I first went to see this doctor (a specialist), I was told that he did NOT have electronic health records for patients to access!
During my 2014 office visit, I asked at the front desk if they participated in electronic health records for patients. Although this practice provided no paperwork or signs advertising electronic record signup, I had gotten into the habit of asking anyway. I was told that they did not have electronic health record sign-up. When I was checking out, I asked again (maybe they didn’t know at the front desk) and the answer was still no. I was disappointed but resolved not to come back to this doctor again.
One of the requirements for Stage 1 payment was to “provide patients with an electronic copy of their health information, upon request”. Although 2014 was later than the official reporting periods, I would like to assume that any EHR Patient Portal created in 2011-13 did not cease to exist after the reporting periods ended! How did this doctor get away with not providing an EHR Patient Portal and still get so much money? A medical professional can be excluded from providing patients with electronic health records if he had no patients or their agents asking for them during the EHR reporting period. What circular reasoning hogwash! Don’t tell patients about electronic health records or their benefits and then cry that not one patient in three years asked for them. Could I have been the lone patient to ask? Most people, let alone sick patients, had never heard of electronic health records (especially in 2011-13) when these doctors were collecting incentive money. Our government provided no funding “incentivizing” patients to sign-up for electronic health records and then expects them to somehow acquire the information out of thin air. In my experience, patients not only have to go out of their way to sign-up and use EHR Patient Portals, they also have to navigate many roadblocks to get any content from them.
My Investigation–Meaningful Use Program Scam?
With the new information about incentive payments, I decided to investigate further. I called the doctor’s office and asked the representative on the phone whether EHR Patient Portal signup was available. She told me that the doctor’s practice (a heart/vein specialty group practice with five medical professionals) had been “sold” to the local hospital the year before (in 2015, eight months after my initial visit). I also noted that the other four doctors in this group practice each received the same incentive payments as had my doctor.
I asked if the specialist was still practicing in his office and she said yes. The doctor’s representative on the phone also told me they were just getting around to setting up the doctor’s records for electronic health record input into the hospital’s EHR Patient Portal system. The non-existent doctor’s EHR Patient Portal for which he had received $40,000 to date (he received an additional $2,000 in 2016 for the 2015 reporting period) was no longer of concern since he now had the hospital’s EHR Patient Portal system to use. I later discovered that this doctor was now practicing under a different business name with a larger group of doctors representing various specialties. Interestingly, the 2015 payment listed a different address than the earlier payments and was a vacant, for sale, medical building. It should be noted that the local hospital received over $3.7 million for its own EHR in 2013-14. The more I investigate, the fishier the smell.
I told the doctor’s representative that I wanted to sign-up for the hospital-based EHR so that I could download my test results. She told me that I could signup (she would send be an email invitation), but the 2014 test results would not be in the EHR but she could mail me a paper copy of the test results. The paper copy of the test results consisted of an “electronically signed” summary document identified as coming from an “Electronic Medical Record (EMR)” This is an electronic medical record that is only for internal use within the healthcare business and is not the same as the Electronic Health Record (EHR) that I, the consumer have access to in my EHR Patient Portal. Obviously this medical professional did not choose to share this health record in electronic form with me. Later, when I accessed my hospital-based EHR, it had nothing more than my name on it! I have summarized my investigation in the cartoon below.
Call To Action
What do I plan to do about this possible fraudulent misappropriation of taxpayer funds? Our government has made it clear from the beginning that the consumer is not to participate in the Medicare and Medicaid EHR Incentive Program that hands out taxpayer money to doctors. Our input would have helped keep this type of less-than-honest behavior in check. How many doctors (and hospitals) have been less than honest in the self-attestation process to get their incentive money? After discovering the above disconnect with reality, all of the government’s rosy statistics on EHR implementation come into question. These statistics are generated from self-attestation (i.e., the medical professional said he did it, therefore it must have happened) and are not verified by patients.
I will be lodging a formal complaint with our government regarding this situation. I am not sure where this kind of complaint belongs, because our government does not want patient complaints about EHRs. Digging around online I found three places to present this case:
- Health IT Complaint Form— As expected, this complaint form is under the “Provider & Professional” tab and not under the “Patients & Families” tab of the government site.
- U.S. Department of Health and Human Services’ Office of Civil Rights
- Figliozzi and Company –this is the EHR auditing contractor for The Centers for Medicare & Medicaid Services (CMS); mailing address: 100 Garden City Plaza Suite 225; Garden City, NY 11530; email: email@example.com
CMS warns doctors that they “can be subject to an audit” and “documentation to support the attestation should be retained for six years post-attestation”. Furthermore, “if the provider is found to be ineligible for an EHR incentive payment, the payment will be recouped.” With such a small penalty for getting caught, I would be surprised if this manipulation of the government program and its funds is not widespread.
The Bottom Line
In the years 2011-2014, the eligible professional I describe above was paid EHR incentive money for an EHR Patient Portal that was not available (or did not even exist) to his patients. Did you ask for electronic health records at your doctor’s office and were told they didn’t have them? As a taxpayer, you may have paid your doctor for something he did not deliver. I encourage you to look at the list of doctors who have received incentive payments in the website shown above. If your doctor is listed and you know he didn’t provide shareable electronic health records, then I encourage you to lodge a complaint as I have done above. If there is a better way to lodge a complaint, please share this information in the comment section. I am also very eager to hear from other people’s experiences with their EHR Patient Portals.
I can’t help thinking that a short, online (government website) questionnaire filled out by patients after each appointment would have been enough to keep EHR attestations honest. I would have welcomed a direct email questionnaire from the government too. Because patient input is absent from this program, I would guess that the case I present above is the tip of the iceberg. How many audits has the government performed and where are the results? How honest have the attestations proven to be? Let’s work together and get some of our wasted taxpayer money back.