Archive

July 14, 2023

Electronic health record technology vendor NextGen Healthcare Inc. has agreed to pay $31 million to resolve a whistleblower’s allegations that it misrepresented the capabilities of certain software and improperly induced users to recommend the software. According to two users of the NextGen’s software, Toby Markowitz and Elizabeth Ringgold, the company allegedly violated the False Claims Act by concealing from a certifying entity that its technology lacked critical but required functions. Additionally, the company allegedly violated the Anti-Kickback Statute by giving credits worth up to $10,000 to customers whose recommendation of NextGen’s EHR software led to a new sale. For launching a successful qui tam case, the whistleblowers will receive and share a $5.6 million share of the recovery. DOJ

Tagged in: Anti-Kickback and Stark, Electronic Health Records, FCA Federal, Healthcare Fraud, Whistleblower Case, Whistleblower Rewards,

November 1, 2022

Electronic health record technology vendor Modernizing Medicine, Inc. (“ModMed”) has agreed to pay $45 million to resolve allegations, including by its former VP of Product Management, that it both received and provided illegal kickbacks in exchange for referrals. According to the government and whistleblower Amanda Long, ModMed engaged in schemes with Miraca Life Sciences, Inc. (now known as Inform Diagnostics) to receive kickbacks in exchange for recommending its users for Miraca’s lab services, and to provide its EHR technology free to healthcare providers to entice them to direct lab orders to Miraca and add to ModMed’s user base. Long will receive about $9 million of the settlement with ModMed. DOJ

Tagged in: Anti-Kickback and Stark, Electronic Health Records, FCA Federal, Healthcare Fraud, Laboratory and IDTF, Whistleblower Case, Whistleblower Rewards,

January 28, 2021

Electronic health records vendor athenahealth Inc. will pay $18.25 million to resolve claims brought in two separate whistleblower actions alleging that certain Athena marketing programs provided unlawful remuneration to healthcare providers and others to induce providers to purchase Athena’s EHR systems. Remuneration to current and prospective customers included all-expenses paid trips to sporting, entertainment, and recreational events, as well as cash payments to customers who referred others to Athena. In addition, Athena paid other EHR vendors who referred clients to Athena when they were discontinuing their own EHR products and services. The kickbacks allegedly improperly generated sales for Athena while causing healthcare providers to submit false claims to the federal government for incentive payments related to the adoption and “meaningful use” of Athena’s EHR technology. The whistleblowers, Geordie Sanborn, Cheryl Lovell, and William McKusick, will receive a share of the total settlement that remains to be determined. DOJ; USAO Mass

Tagged in: Anti-Kickback and Stark, Electronic Health Records, FCA Federal, Healthcare Fraud, Provider Fraud, Whistleblower Rewards,

September 22, 2020

New Jersey biotechnology company Bio-Reference Laboratories, Inc., will pay $11.5 million to resolve two actions brought by whistleblowers alleging that defendant violated the Anti-Kickback statute by paying unlawful remuneration to physicians based on the volume of those doctors’ referrals to defendant. The remuneration took the form of payments for a percentage of the cost of electronic medical records software used by the doctors. In addition, defendant was alleged to have unlawfully billed Medicare and Tricare for testing performed on hospital inpatients, instead of billing the hospitals themselves. USAO SDNY

Tagged in: Anti-Kickback and Stark, Electronic Health Records, Healthcare Fraud, Laboratory and IDTF, Medical Billing Fraud,

January 27, 2020

Practice Fusion, Inc., a provider of electronic health records systems, will pay $145 million to resolve criminal and civil charges that it accepted unlawful kickbacks from pharmaceutical companies and misrepresented the capabilities of its EHR software. As part of the settlement, the defendant entered into a deferred prosecution agreement, paying $26 million in criminal fines and forfeitures, agreeing to compliance policies and monitoring, and admitting that it accepted payment from an unnamed opioid manufacturer in exchange for including "clinical decision support" alerts within its EHR system that were designed to increase prescriptions for the pharma company's drugs. The civil settlement – $119 million for the federal government and up to an additional $5.2 million for states that choose to opt in – resolves the kickback allegations related to the opioid manufacturer and 13 other such arrangements, as well as allegations that Practice Fusion knowingly misrepresented the capabilities of its EHR system in order to secure federal certification for the software and secure eligibility for federal incentive payments for providers adopting its software. DOJ; USAO VT

Tagged in: Anti-Kickback and Stark, Criminal Proceedings, Electronic Health Records, FCA Federal, Healthcare Fraud, Pharma Fraud,

May 31, 2019

A Kansas hospital accused of submitting false claims to Medicare and Medicaid has agreed to pay $250,000 to settle a qui tam suit by Bashar Awad and Cynthia McKerrigan, with about $50,000 of the recovery going to the whistleblowers. According to the suit, from 2012 to 2013, Coffey Health System falsely attested to having conducted or reviewed security risk analyses of electronic health records (EHR), which was a requirement under a federal incentive program that pays healthcare providers for adopting certified EHR technology. USAO KS

Tagged in: Certifications, Electronic Health Records, FCA Federal, Hospital Fraud, Medicaid, Medicare, Whistleblower Case, Whistleblower Rewards,

May 23, 2019

Sixteen states have reached a settlement with the Medical Informatics Engineering and NoMoreClipboard, LLC, which have agreed to pay $900,000 to resolve allegations that the companies violated the Health Insurance Portability and Accountability Act (HIPAA), unfair and deceptive practice laws, notice of data breach statutes, and state personal information protection laws. The companies provide patient portals to healthcare providers, enabling patients to access their health records. Hackers allegedly infiltrated the companies' servers in May 2015, stealing the information of more than 3.9 million individuals. A consent judgment with specific compliance agreements was also entered by the court. FL; NC

Tagged in: Cybersecurity and Data Breaches, Electronic Health Records,

February 6, 2019

An electronic health records provider, Greenway Health LLC, will pay $57.25 million to settle a False Claims Act case brought by the U.S. alleging that Greenway fraudulently obtained certification that is product, Prime Suite, complied with HHS requirements and therefore that healthcare providers using Prime Suite could receive payments under the Medicare and Medicaid EHR Incentive Program. Greenway allegedly modified the software tested by the certification body to make it appear that Prime Suite was performing as required when it was not, and failed to correct known errors in the software. In addition, the government alleged that Greenway violated the Anti-Kickback Statute by providing incentives including payments to clients to recommend Prime Suite. Greenway entered into a five-year Corporate Integrity Agreement which includes an independent monitoring process. DOJ

Tagged in: Anti-Kickback and Stark, Electronic Health Records, FCA Federal, Healthcare Fraud,

December 12, 2017

Florida-based 21st Century Oncology Inc. agreed to pay $26 million to settle charges of violating the False Claims Act and the Stark Law through the company’s false attestation to the use of electronic health records software and through referrals from physicians with whom the company had improper financial relationships. DOJ

Tagged in: Anti-Kickback and Stark, Electronic Health Records, FCA Federal, Provider Fraud,

May 31, 2017

Massachusetts-based eClinicalWorks, one of the country's largest vendors of electronic health records software, along with certain of its employees, agreed to pay $155 million to resolve charges the company violated the False Claims Act by misrepresenting the capabilities of its software. The company also allegedly paid kickbacks to certain customers in exchange for promoting its product. The allegations originated in a whistleblower lawsuit filed under the qui tam provisions of the False Claims Act by Brendan Delaney, a software technician formerly employed by the New York City Division of Health Care Access and Improvement. He will receive a whistleblower award of roughly $30 million from the proceeds of the government's recovery. DOJ

Tagged in: Contract Non-Compliance, Electronic Health Records, FCA Federal, Government Procurement Fraud, Healthcare Fraud, Whistleblower Case, Whistleblower Rewards,

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