A Look at the Electronic Health Record Incentive Program

In 2009, Congress passed the Stimulus Package, which, among other things, established incentive payments under the Medicare and Medicaid programs for eligible healthcare providers that “meaningfully use” Certified Electronic Health Record Technology. The incentive programs were created to promote the adoption of health information technology and encourage the electronic exchange of health information in order to improve the quality and lower the cost of health care in the United States.

To guard the gates of this program, Congress required providers to satisfy certain conditions. Of particular note, Congress only permitted CMS to disburse incentive payments after an eligible provider certified that it had meaningfully used Certified Electronic Health Record Technology for the prior fiscal year.

As of late last year, over 80% of the roughly 5,000 hospitals eligible for the program had certified that they satisfied the “meaningful use” requirement. This resulted in over $9 billion in payments to hospitals, and another $6 billion to other healthcare providers.

A percentage of Certifications have falsely claimed to meet the “meaningful use” requirement, thus allowing providers to wrongfully receive millions of government healthcare dollars. In one example, the government indicted a hospital CFO for allegedly certifying that his hospital meaningfully used Certified Electronic Health Record Technology, when the hospital had supposedly relied on paper medical records for months.

Because of the widespread disbursement of “meaningful use” incentives, the government is unable to adequately verify whether providers are truthfully attesting to their EHR capabilities. The potential whistleblower rewards are substantial in this area.

More information for whistleblowers is located at the Nolan Auerbach & White website.