Only a small percentage of providers attesting to Meaningful Use will be audited by the government, but the outcome could be harsh, since any single shortfall will be grounds for loss of the full incentive payment, according to attorney Brian Flood with Husch Blackwell in Austin, Texas, who spoke on a webinar conducted Sept. 26, by the American Bar Association’s Health Law Section.

“You get no credit for getting 90 percent. You owe all of the money back,” Flood warned.

One of the problems tripping up audited providers the most is the inability to prove that they met the Meaningful Use requirements because they didn’t retain relevant supporting documentation, according to David Zavala, senior manager with consulting and internal audit firm Protiviti, who also spoke on the webinar.

“In Stage 1, there were probably a lot of attestations put together at the last minute,” Zavala said. “A lot of organizations kind of took it lightly and now realize there was a lot more they should have done.”

Providers also are having trouble demonstrating that they have conducted an adequate security risk assessment of their system’s vulnerabilities, as required by Core Measure 15.

Several of the red flags that might trigger an audit, according to the speakers, include:

  • Elements of attestation, such as inconsistencies in numerators and denominators that should be related
  • Attestation data that’s inconsistent with Centers for Medicare & Medicaid Services data, such as measures inconsistent with the providers’ patient mix, or local public health capabilities
  • Vendor characteristics. “Some vendors are known for having issues with their systems,” Zavala said. “Those systems are more likely to be subject to an audit.”

The Meaningful Use audits, which include both pre- and post-payment audits, began in 2012 and are continuing.


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