About one in 20 participants in the federally funded electronic health-record incentive payment program can expect to be audited for compliance with meaningful use and other program criteria, a federal official said Monday.
In January, the CMS extended a second arm to its audit program for the EHR incentive payment program under the American Recovery and Reinvestment Act, adding payment applicants to an audit target list that since October 2012 has included only providers whose payments already have been received.
Pre-payment and post-payment audits will garner roughly equal amounts of federal attention going forward, with a goal of auditing 5% of program participants overall, Robert Anthony, deputy director of the HIT Initiatives Group at CMS, said in a telephone update of federal audit efforts thus far.
“It's only recently that some of the adverse-finding letters have gone out,” Anthony said. So far, there have not been many, “although some of that may be timing,” since it's still early in both programs. A few providers with adverse audit determinations are just beginning the appeal process, he said. Several providers have been referred for possible fraud enforcement investigation and action.
“We didn't find them in the process of going through an audit, but we've had them reported to us from other folks,” he said.
Most of the reviews will be “desk audits” conducted by the CMS' audit contractor, Figliozzi and Co., with information exchanged electronically, although a few on-site audits could be conducted, Anthony said.
One of the most common problem areas turned up by auditors thus far has been noncompliance with the requirement that providers complete a data security risk assessment, also a requirement under the Health Insurance Portability and Accountability Act of 1996. A finding of non-compliance with HIPAA could be shared with the Office for Civil Rights at HHS, Anthony said. The civil rights office wrapped up its own series of 115 random HIPAA privacy and security audits in December. A final report on those audits is expected soon, according to a civil rights office spokeswoman.