Menacing Healthcare Fraud in Electronic Records Probed by DOJ After $155 Million Settlement

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Person Wearing Blue Sterile Gloves - setting a good example, representing healthcare fraud

“An entirely new area of healthcare fraud”

The Department of Justice (DOJ) is expected to investigate electronic health record (EHR) software providers for health care fraud following allegations against a major player that resulted in a $155 million settlement under the False Claims Act for skirting meaningful use regulations.

In a recently released video, a Senior Counsel at the Office of the Inspector General called false statements during certification and manipulation of the certification process by EHR vendors “an entirely new area of healthcare fraud.” Although the government is not expected to pursue hospitals that used the software in good faith, the United States seems willing to pursue vendors for false certifications and statements that could have a detrimental impact on patient care.

The United States offers incentive payments to healthcare providers that adopt certified EHR software and meet certain meaningful use requirements, as set forth in the American Recovery and Reinvestment Act of 2009. Companies that sell EHR software must attest that it satisfies criteria set by the Department of Health and Human Services as well as pass testing by an approved, accredited independent certifying entity.

Earlier this year, eClinicalWorks agreed to pay $155 million to resolve allegations brought under the False Claims Act that it misrepresented the capabilities of its software and paid kickbacks to customers for promoting the product. The government complaint alleged that the software did not comply with the standards for certification, because it could not retrieve a drug code from a complete database, did not accurately record user actions in an audit log, did not perform drug interaction checks, and failed to satisfy data portability requirements.

Individuals that report evidence of healthcare fraud through the False Claims Act may be eligible for rewards of between 15 and 30 percent of the government’s recovery. In the case against eClinicalWorks, the whistleblower received $30 million. If you have evidence of fraud by an EHR vendor, please call for a free initial and confidential consultation with Eric Young or another False Claims Act attorney at Young Law Group.