EHR copy-and-paste function: Fraud or efficiency?

Cloning notes in electronic health records (EHRs) has drawn criticism from a top government report, calling the practice fraud. However, those in the medical field have complained for years that lack of time and poorly designed systems are the real reasons for billing mistakes.

A report by the Department of Health and Human Services Office of the Inspector General (OIG) calls out the Centers for Medicare and Medicaid Services (CMS) for failing to implement measures to prevent fraud. The New York Times reported last week that the federal government’s $27 billion program launched in 2009 to encourage EHR use in practices and hospitals may have suffered from “hundreds of millions of dollars” of fraudulent activity.

The OIG points the finger at “cloning” – the copy-and-paste function used in most EHR systems that allows the person inputting information to duplicate codes across different records. “…inappropriate copy-pasting could facilitate attempts to inflate claims and duplicate or create fraudulent claims,” the report stated. Also, the OIG blamed EHRs that auto-populate fields for “suggesting the practitioner performed more comprehensive services than were actually rendered.”

According to the New York Times, CMS released a statement that called fraud prevention a “top priority.” The OIG suggested that CMS make fraud prevention strategies clearer to providers and suggested disabling the copy-and-paste function on EHRs.

According to physicians and other medical professionals on social media who have commented about the controversy, they use the copy-and-paste functions in EHR the same way that many people use it for other computer functions; to save time when they know they have to duplicate information.

Michele McGlynn, chair of Health Information and Management Systems Society (HIMSS) EHR Association, says that more talk between EHR companies, providers, and others in healthcare needs to happen before new policies are made.

"We, of course, agree that providers should document accurately for both clinical and payment purposes, but feel that constraining technology features is not the solution," McGlynn told Medical Economics.  "We feel strongly that CMS would benefit from the insights the EHR Association can bring to this discussion as to best practices, policies, and recommendations regarding these features, having implemented and supported thousands of EHR systems collectively."

Poorly designed EHRs coupled with physicians having to revisit records to make sure that they are accurate could be a cause for activity that looks like fraud on a record, Jason Mitchell, MD, director of the Center for Health IT for the American Academy of Family Physicians told InformationWeek.com regarding the EHR fraud accusations.

“Going back into records and correcting them when an error is found isn't fraud," Mitchell stated. "It's essential to correct records so that errors don't propagate through.”

The issue of EHR fraud has been under scrutiny for years, gaining momentum as the Meaningful Use incentive program was launched. Medicare contractors, including National Government Services, reported in September 2012 that it would deny claims from what seemed to be cloned documents.

With new reports from the New York Times about the rise in demand for medical scribes to input EHR information for providers, it is unclear whether these extra hands on medical records will help deflate fraud claims or make the issue more complicated.