The HITECH incentive program has been under pressure recently from Congressional critics.  But now more fuel has been added to the fire, and it’s coming from within HHS itself.

A newly released report from HHS’ Office of Inspector General (OIG) points to operational inadequacies which, OIG says, “leave the program vulnerable to paying incentives to professionals and hospitals that do not fully meet the meaningful use requirements.”

The report also notes that “CMS has not implemented strong prepayment safeguards, and its ability to safeguard incentive payments postpayment is also limited.”

The report comes close on the heels of efforts by Congressional critics to ensure that Meaningful Use is moving the healthcare sector forward to the greatest degree possible.

To correct the situation, OIG recommended, among other things, that “CMS . . . obtain and review supporting documentation from selected professionals and hospitals prior to payment to verify the accuracy of their self-reported information.”

According to the report, CMS officials have rejected that recommendation on the grounds “that prepayment reviews would increase the burden on practitioners and hospitals and could delay incentive payments.”

Also in the report, OIG replied that “While we recognize that (requiring prepayment reviews) would impose an increased burden on the professionals and hospitals selected by CMS, that burden would be justified by the reduced likelihood of making improper incentive payments to high-risk professionals and hospitals.  We note that the timing constraints CMS raised do not apply to all practitioners and hospitals, and therefore do not justify forgoing prepayment reviews altogether.  We further note that our recommendation leaves the decision of how to select high-risk professionals and hospitals to CMS’s discretion; as such, CMS can select a methodology that appropriately accounts for the logistical and timing constraints it faces.”

While the OIG report looks specifically at the Medicare side of the incentive program, stakeholders should remember a similar report from 2011 that took an early look at several of the state Medicaid incentive payment programs that were just then getting started.

At that time, OIG reported, among other things, that over half of the states that inspectors looked at “do not plan to verify whether practitioners and hospitals actually adopted, implemented or upgraded EHRs prior to payment, because states do not have an existing data source for this.”

We’ve seen no follow-up to that report, but when taken together, the two reports suggest rather strongly that even as policymakers work on planning the future of MU, they should also be taking more steps to ensure that taxpayer support is currently being put to the highest and best use possible.