An electronic health record (EHR), as its name suggests, is an electronic record of health-related information. EHRs immediately and securely presents patient-related information to authorized users. It’s the digital form of a patient’s paper chart, but it contains much more information than the medical and treatment history of a patient.
EHR systems are designed to perform functions beyond standard data collection, such as helping providers to effectively diagnose patients and provide coordinated and efficient care. A well-integrated EHR system can greatly streamline operational efficiencies and provide a host of benefits to medical practitioners.
A few years ago, EHR systems were considered a luxury, but that’s changed now. EHR systems are now a necessity for healthcare providers to function with optimal efficiency. However, the growth in EHR has also resulted in a growing number of electronic health records fraud.
What’s EHR Fraud?
EHR systems are complex, and they must function properly because the lives of patients depend on them. But, because of their complexity, there are plenty of areas where fraud could be committed in such systems
A detailed investigation revealed the damage these systems were causing. Here are some of the ways they found the EHR systems were being misused:
- Overcharging: It was found that EHR software could be rigged to overcharge patients. This malpractice is known as “upcoding”.
- Lack of interoperability: EHRs were built so that patients could swiftly share all their medical details with doctors or hospitals anywhere in the U.S. But, hundreds of competing firms sold EHR systems that are incapable of exchanging information with each other.
- Patient abuse: A decade ago, the US government believed that switching to EHRs would help provide safer healthcare to individuals. Contrary to that, EHRs have given rise to a variety of risks to patient safety.
Software problems, user errors, and poor implementation have resulted in deaths, critical injuries, and thousands of near-misses. Over the years, thousands of patients have received wrong prescriptions because of this.
In addition to that, EHR fraud has been committed by large companies. Once touted as the “Facebook of health”, errors on the companies’ end resulted in thousands of patients being wrongly prescribed with addictive opioids.
Spotting An EHR Fraud
EHR systems impact the lives of thousands of patients. Even the tiniest of errors could result in patients losing their lives.
Here are a few tips to spot possible EHR fraud:
- The EHR software glitches frequently for simple tasks, like split billing.
- A provider receives financial payments for promoting a particular EHR software.
- The patient notes in an EHR seem to be copy-pasted, like the weight or blood pressure being consistently identical.
- The EHR is set up in a way where it cannot be altered easily. This is also known as “hardcoding”, and it is usually done to pass certification tests.
If you notice any of these signs in your EHR, become a whistleblower to maintain the integrity of the healthcare system.
Steps To Prevent EHR Fraud
It’s essential to establish policies and procedures that prevent such acts of fraud from occurring.
Here are some ways to achieve this:
- Copy and paste documentation: The circumstances under which documentation between sources can be copied and pasted need to be made clear. When this is done, the information needs to be updated to ensure accuracy.
- Audit logs: Audit logs that record data, such as user stamps, date, and time for updates in the EHR, can be crucial tools to prevent fraud. These logs could be used to find data inconsistencies and monitor activity.
- Access controls: Secure access controls and user authentication could prevent unauthorized access to an EHR system. This helps prevent the theft of provider and patient information.
Once an EHR fraud has been observed, stepping forward to report it could result in ensuring the safety of many patients. The Federal False Claims Act or FCA has several measures in place to protect whistleblowers from employer retaliation. This implies that a whistleblower can’t be laid off, demoted, or refused normal employee benefits as a retort to them complaining against fraudulent activities.
If you find yourself in a spot like this, it is best to contact an experienced attorney who can guide you and offer protection. It may feel daunting to stand up and take legal action, especially when dealing with an organization that is large and influential. But, doing so can have a positive impact and save the lives of many individuals. Additionally, whistleblowers generally receive a portion of the settlement as a reward if the Department of Justice finds proof of fraud and takes up the case.