Shining a little light and a little heat on the issue of EHRs and fraud

Abstract

There was a flurry of public attention concerning electronic health records (EHRs) and fraud during a single week in September 2012. First, the Center for Public Integrity, a non-profit investigative news organization, published a study that showed an increase in Medicare billings concomitant with the switch to EHRs. A front-page article in The New York Times followed on the same subject. Then an hour on National Public Radio (NPR) was devoted to the pros and cons of EHRs and cited both publications. Finally, an editorial in The New York Times discussed EHR abuse and called for action to prevent fraud from detracting from the positive effects of EHR implementation. Although it was widely acknowledged that, indeed, billings, particularly E&M code levels, had increased after hospitals and practices had switched to EHRs, there were mixed opinions as to how much of this increase represented legitimate improvements in documentation and even legitimate improvements in overall care, and how much was fraudulent. Opinions are mixed primarily because all we have are opinions—not facts, as this issue has not been studied. There are logical reasons to believe that the increase in billing is, at least in part, legitimate, and even reflects better patient care. On the other hand, there are equally logical reasons to suspect that many of the tools embedded in EHRs are used fraudulently. There is undoubtedly some of each going on. The question is: Where do we go from here? Judging from the reactions to these events, …