Medicaid Doctors and Dentists Gaming the EHR Incentive Program

I guess I should have known that it would only be a matter of time before I’d see something like this come out. As best I can tell, Dentrix has partnered with Henry Schein to offer what they’re calling Dentrix Meaningful Use Access 7.6. Seems like Henry Schein is using the Dentrix names to get Dentists access to the Medicaid EHR incentive money. On face, I don’t see any problem with this.

Although, once you start to dig into it, it appears that Dentrix and Henry Schein are partnering to get Dentists the first Medicaid EHR incentive check without even implementing the EHR. You have to remember that the Medicaid EHR stimulus money doesn’t require you to show meaningful use of the EHR. You just have to acquire the EHR technology.

Look at some of the verbiage from the website for the program:

Definition of Adopt, Implement, or Upgrade:
For Medicaid, the eligible provider must Adopt, Implement, or Upgrade (AIU) certified EHR software. As posted on the CMS website, for AIU, a provider does not have to have installed certified EHR technology. The definition of AIU in 42 CFR 495.302 allows the provider to demonstrate AIU through any of the following:
*Acquiring, purchasing or securing access to certified EHR technology
*Installing or commencing utilization of certified EHR technology capable of meeting meaningful use requirements
or
*Expanding the available functionality of certified EHR technology capable of meeting meaningful use requirements at the practice site, including staffing, maintenance, and training, or upgrade from existing EHR technology to certified EHR technology per the ONC EHR certification criteria.

Thus, a signed contract indicating that the provider has adopted or upgraded would be sufficient.

To be honest, I’m torn between whether this is genius or filthy. According to the letter of the law, I don’t know of any reason that someone with the right Medicaid population can’t purchase an EHR like this for $2000 and then collect the EHR incentive money. The regulations don’t require them to do any more to collect the money. Although, that’s certainly not the intent of the EHR incentive money and definitely feels like their gaming the system if they do it with no intent to actually implement the EHR.

Another piece from the website:

While Henry Schein currently has no plans to pursue a Meaningful Use solution beyond Stage 1, Year 1 for Dentrix, we continue to monitor healthcare reform to determine what subsequent steps, if any, should be taken regarding Meaningful Use criteria and certification.

At least their up front with the Dentists that they’re not planning to go beyond meaningful use stage 1, but may change their minds. I’m sure this is music to ONC’s ears to hear that they’re only committing to meaningful use stage 1.

If your strategy is to just help these dentists get the first EHR incentive check, then why should you worry about MU stage 2. Wouldn’t you love to be a salesperson for this product? Here’s your pitch: Pay me $2000 for this EHR, go through 5 steps on the government website and you’ll get paid $21,250.00.

I wish I could see something legally wrong with this idea. Someone I talked to mentioned that even for the Medicaid EHR incentive money you have to check some box saying that you comply with the HIPAA requirements. Well, these clinics have to do that anyway. Many don’t, but they’ll check that box anyway thinking that they comply whether they do or not.

The biggest surprise for me might be that Henry Schein is willing to have their name associated with a program like this. I’ll be interested to see who else picks up on this glaring issue with the Medicaid EHR incentive and what ONC/CMS/HHS do to close it up (if they can).