In August 2016, OIG released a series of reports focusing on the Medicaid electronic health record (EHR) incentive program for hospitals in West Virginia, Ohio, and Oklahoma.  This continues a recent trend of reports focusing on Medicaid EHR incentive payments to hospitals.  As noted in these OIG reports, the Congressional Budget Office estimates that, from 2011 through 2019, spending on the Medicare and Medicaid EHR incentive programs will total $30 billion.  The Medicaid EHR incentive program is expected to account for more than a third of the $30 billion EHR payment estimate (about $12.4 billion).  Accordingly, OIG explained that these reviews were designed to determine whether the State agencies made Medicaid EHR incentive program payments to eligible hospitals in accordance with Federal and State requirements. 

OIG Report: West Virginia Made Incorrect Medicaid Electronic Health Record Incentive Payments to Hospitals (August 2016)

According to the OIG report available here, the West Virginia Department of Health and Human Resources, Department of Medical Assistance Services (the WV State Agency) made approximately $70.6 million in Medicaid EHR incentive program payments to providers between July 1, 2011 and December 31, 2013.  OIG reviewed hospitals that received an incentive payment totaling $1 million or more.  There were five hospitals included in OIG’s review.

According to OIG, the WV State Agency did not make EHR incentive payments in accordance with Federal and State requirements for three of the five hospitals included in the review. Specifically, OIG concluded that the WV State Agency overpaid three hospitals $295,962. Because the hospital EHR incentive calculation is computed once and then paid out over 3 years, payments after December 31, 2013, will also be incorrect, according to OIG.  OIG concluded that these errors occurred because the WV State Agency calculated the EHR payment using hospital-provided data that was not validated.

OIG recommended, among other things, that the WV State Agency refund the overpayment to CMS and review the additional hospitals not included as part of OIG’s review.

OIG Report: Ohio Made Incorrect Medicaid Electronic Health Record Incentive Payments (August 2016)

Using the same review structure described above, according to the OIG report available here, from January 1, 2011, through December 31, 2012, the Ohio Department of Medicaid (the Ohio State Agency) made incorrect Medicaid EHR incentive payments totaling $526,000 to 10 hospitals.  The OIG’s review identified both underpayments and overpayments and resulted in a net overpayment of $524,000.

OIG concluded that these errors occurred because the Ohio State Agency did not ensure that the hospitals had removed all bad debt/write-offs from charity care when calculating the EHR incentive payments. OIG also recommended, among other things, that the Ohio State Agency refund the overpayment and review the remaining hospitals not included in OIG’s review.  

OIG Report: Oklahoma Made Incorrect Medicaid Electronic Health Record Incentive Payments to Hospitals (August 2016)

According to the OIG report available here, the Oklahoma Health Care Authority (the OK State Agency) did not always pay EHR incentive program payments to eligible hospitals in accordance with Federal and State requirements for program years 2011 and 2012.  The OIG report concluded that the OK State Agency overpaid seven hospitals out of the twenty-five hospitals reviewed a total of $1.1 million.  Additionally, OIG’s review concluded that the OK State Agency underpaid four hospitals a total of $402,000, which resulted in a net overpayment of $680,000.

OIG determined that while the OK State Agency reviewed certain supporting documentation submitted by the hospitals and made corrections, the errors identified during the review occurred because it did not review all of the supporting documentation.  Again, OIG recommended, among other things, that the OK State Agency refund the overpayment and review the additional hospitals not included as part of OIG’s review.

All Medicaid meaningful users nationwide should be mindful of potential recoupment efforts by State Medicaid agencies for prior Medicaid EHR incentives payments.