Anti-fraud requirements for EHRs in development

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RTI International is developing electronic health record (EHR) functionalities and requirements to prevent fraudulent data collection by public and private healthcare systems. The initiative will also seek ways to evaluate the submission of fraudulent data and analyze it to reduce the number of fraudulent claims and improper payments in the future. The six-month project, worth almost $500,000, was awarded to RTI by the Office of the National Coordinator for Health Information Technology (ONCHIT). Under the terms of the contract, RTI researchers will work with the American Health Information Management Association (AHIMA) and SPSS to take a proactive approach to preventing healthcare fraud. "Currently, most fraud is detected post payment, which makes dealing with the claims very inefficient," said Colleen McCue, PhD, a senior research scientist at RTI and project manager. "If we can detect errors at the time the record is created, we can not only eliminate improper payments but also improve the quality of care." The research team will work with the National Health Care Antifraud Association (NHCAA), healthcare providers, health insurers, federal agencies, the Health Information Technology Standards Panel (HITSP), and the Certification Commission for Health Information Technology (CCHIT). "The model requirements that we propose will help officials predict when and how fraud may occur so they can manage resources and reduce its incidence," McCue said.