When I recently read that a former hospital Chief Financial Officer (CFO) had been charged with health care fraud for falsely attesting to Meaningful Use, I could not believe the corners that he decided to cut. My first thought was that he had not been aware of the Centers for Medicare and Medicaid Services (CMS) track record for auditing to stop improper payments. In fact within a few months of his alleged fraud, CMS announced their pre-payment audits for the Medicare Electronic Health Records Incentive Program which would audit the meaningful use attestations. (See my April 2013 blog on CMS Follows the Money with New Audits.)
Then I wondered, “What must his Chief Executive Officer be thinking of such behavior?” I found that the owner of this hospital had been indicted by a federal grand jury last year on counts of healthcare fraud. It seems that he and others allegedly changed, deleted, and incorrectly sequenced diagnostic codes. Evidently upcoding isn’t extinct. The result of these incidents was the hospital losing its Medicare and Medicaid funding and ultimately closing in July 2013, affecting the community in which it was located.
And there is more. The CFO has also been charged with aggravated identify theft as he allegedly used another person’s name and information without that person’s consent to attest to the hospital’s demonstration of meaningful use.
In both scenarios the person in a position of authority had assistance in completing this fraud. Although it’s not mentioned how the upcoding was accomplished, it’s likely that the owner directed someone in Health Information Management or the Billing Office to change the sequence of codes. In the allegations of the fraud surrounding the meaningful use attestation, the former CFO directed its software vendor and hospital employees to manually input data from paper records into the electronic health record which may have been after the patient was discharged.
What can we learn from these schemes to commit fraud?
- The Tone at the Top cannot be left to one or two people and can often be measured by the middle managers ability to lead by example of how to do the right thing.
- Goals can lead a person to do the wrong thing (thus the reference to goals gone wild). If we are blinded by one goal, we can put our ethics and organization on the line and start sliding down that slippery slope into wrong behavior.
- Employees should be empowered to speak up when someone (even at the top) is asking them to do something that appears to be dishonest.
- Credentials of those who attest to meaningful use and other matters should be protected even from their superiors.
- Eligible hospitals and professionals should have an independent audit of their meaningful use attestation prior to submission.
Let’s hope that none of us are ever put to the test of following a directive vs. our moral compass and if so, that we follow the ethical route.
Camille Cohen is the Compliance Officer with 3M Health Information Systems.