HCA Begins EHR Medicaid Incentive Payment Recoupment Process

April 4, 2018

The Health Care Authority (HCA) is beginning the process of recouping overpayments and correcting underpayments of electronic health record (EHR) incentive payments to hospitals. We believe this may result in a net recoupment as high as $20 million across all impacted hospitals. Affected hospitals will receive notices over the next several weeks.

HCA is now in the process of acting on the Myers and Stauffer (M&S) audit findings to recoup some of the money from the hospitals that received overpayments. There are also a few hospitals the audit determined were underpaid that will receive additional funds. WSHA is working with HCA to understand impacts to hospitals and to get information out to hospitals. A number of hospitals have engaged legal counsel to help them navigate the issue, and WSHA has filed public records requests to help understand the background.

The EHR incentive payments were made to hospitals by HCA through a program funded by the Centers for Medicare and Medicaid Services (CMS). The M&S audit was initiated following an audit of EHR incentive payments to 19 Washington hospitals by the Office of the Inspector General. The OIG determined payments to the 19 audited hospitals were calculated improperly and resulted in $9 million in net overpayments. As a result, HCA contracted M&S to audit the payments of these hospitals, as well as 68 additional Washington hospitals that received EHR incentive payments in order to determine the amount to be refunded to CMS.  (Andrew Busz, andrewb@wsha.org).


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