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Rx for Fraud: Electronic Health Records

Posted On 02/24/14

By pursuing a mandate to digitize medical records, the federal government hopes to improve patient care and reduce costs. But recent reports by the Office of the Inspector General (OIG) indicate that fraud prevention policies remain lacking. Meanwhile, as the nation moves forward with implementing electronic health records (EHRs), it’s time to address the fraud concerns.

An EHR is a digital version of a medical history. As business and medical records migrate online, EHRs are expected to provide the following benefits:

  • Improved accuracy and access to patient medical records and a reduction in medical errors. With an electronic record, a complete medical history is shared among all care providers, along with information about medication and treatments.
  • Reduced hospital wait times and fewer delays in treatment.

However, in reports released in December 2013 and January of this year, the OIG highlights lack of guidelines and insufficient use of fraud safeguards as significant drawbacks to using EHRs to replace standard paper medical records. The most common forms of fraud involving EHRs include the following:

  1. Cloning — When a medical technician or physician duplicates information from one medical history to another, additional billings are generated for services that may not have been performed. Fake information added to any medical history is dangerous and fraudulent.
  2. Upcoding — Defining the condition or treatment of a patient as more serious or complex to generate higher fees is not uncommon and, again, is expensive and illegal.

These practices are not just illegal — they can also jeopardize a patient’s health and insurance status. Furthermore, the potential for fraud using these records puts patients in an extremely vulnerable position.

Migration to a new form of medical recordkeeping is bound to raise issues, and the issues with EHR implementation should be addressed over time. In the meantime, if a medical care provider falsifies your records for financial gain or endangers your health as a patient, talk to an experienced lawyer in Arizona about taking proper legal action.