The federal Stimulus Bill of 2009 launched a Medicare and Medicaid incentive program that encouraged physicians and hospitals to adopt and use certified electronic health record (EHR) systems to improve care and save costs. However, according to a letter the Department of Health and Human Services and the Department of Justice sent to five hospital associations, they are concerned that dishonest hospitals are using the EHR technologies to game the system.

Many EHR systems permit hospitals to simply copy and paste patient narratives and histories, ostensibly saving administrative time. However, dishonest hospitals are engaged in healthcare fraud by using this basic word processing function to facilitate upcoding of the level of care.

Some hospital systems have commented that the current EHR systems actually encourage upcoding by “prompting” providers to download lab test results and patient histories to qualify for higher reimbursement codes. Others have stated that the systems merely ensure that providers are accurately and adequately compensated for their time.

The federal government has vowed to identify hospitals who misuse and abuse EHR technologies to game the Medicare and Medicaid systems. Seemingly innocuous claims rarely reveal upcoding schemes, but with the assistance of whistleblowers, HER upcoding can and will be exposed.

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