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Electronic Health Records

This archive displays posts tagged as relevant to electronic health records and fraud related to electronic health records.

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Top Ten False Claims Act Recoveries in 2023

Posted  01/11/24
It was another big year for DOJ enforcement under the False Claims Act, the government's primary fraud-fighting tool. As usual, most of the recoveries were in the healthcare space with seven of the Top-10 involving various schemes to defraud Medicare and Medicaid. Several of these Top-10 recoveries involved enforcement actions targeting violations of the Anti-Kickback Statute and Stark Law, which prohibit medical...

Tagged in: Anti-Kickback and Stark, Electronic Health Records, FCA Federal, Government Programs Fraud, Healthcare Fraud, Medicaid, Medical Billing Fraud, Medicare, Top 10, Whistleblower Case,

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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,

Catch of the Week: NextGen Healthcare

Posted  07/14/23
Medical Records Review
This week's Department of Justice (DOJ) Catch of the Week goes to electronic health record (EHR) technology vendor NextGen Healthcare Inc.  Today, DOJ announced the company has agreed to pay $31 million to settle charges it violated the False Claims Act by misrepresenting to the government the capabilities of its EHR software and providing kickbacks to its users to induce them to recommend NextGen’s software.  The...

Tagged in: Anti-Kickback and Stark, Catch of the Week, Electronic Health Records, FCA Federal, Healthcare Fraud, Whistleblower Case,

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Top Ten Healthcare Fraud Recoveries of 2022

Posted  01/6/23
Healthcare fraud image showing stethoscope with gavel
Consistent with the trend in prior years, 2022 saw government enforcement agencies taking aim at fraud and false claims in healthcare.  As the cost of healthcare rises along with its share of the U.S. economy, the enforcement focus on healthcare fraud is likely to accelerate. And, as always, the role of whistleblowers will be critical, as demonstrated by the dominance of cases originated by whistleblowers under the...

Tagged in: Electronic Health Records, FCA Federal, Healthcare Fraud, Medicaid, Medicare, Other Government Health Programs, Pharma Fraud, Private Insurance Whistleblower Reward Programs, Provider Fraud, Top 10,

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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,

DOJ Previews False Claims Act Enforcement Priorities for 2021

Posted  03/5/21
Department of Justice Seal on the United States Flag
The False Claims Act is the federal government's primary enforcement tool to combat fraud against the public.  Every year the government recovers billions of dollars under the statute, primarily with the help of whistleblowers.  Under the so-called qui tam provisions of the act, whistleblowers are authorized to act as private attorneys general and bring lawsuits on behalf of the government and recover a portion of...

Tagged in: COVID-19, Cybersecurity and Data Breaches, Electronic Health Records, FCA Federal, Government Procurement Fraud, Government Programs Fraud, Healthcare Fraud, Home Health and Hospice, Importance of Whistleblowers, Pharma Fraud, SNF,

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Catch of the Week: EHR Vendor Athenahealth Settles Kickback Cases Brought by Whistleblowers

Posted  01/29/21
Computer screen showing electronic medical records system with ICD 10 codes
Athenahealth Inc. agreed to pay $18.25 million to resolve allegations that the electronic health records company violated the False Claims Act by paying unlawful kickbacks to potential customers and others.  The government’s investigation was prompted by two whistleblower actions filed in 2017; the actions were consolidated and the government filed a complaint in intervention immediately prior to the...

Tagged in: Anti-Kickback and Stark, Catch of the Week, Electronic Health Records, FCA Federal, Healthcare Fraud, Whistleblower Case,

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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,

Top Ten Healthcare Fraud Recoveries of 2020

Posted  01/5/21
Healthcare Fraud
Consistent with the trend in prior years, the bulk of the Justice Department’s fraud and false claims recoveries in 2019 stemmed from healthcare fraud matters, and with the Biden administration eyeing a bigger role for the federal government in our healthcare system, this trend is likely to accelerate. Most of the funds recovered arose from cases originated by whistleblowers under the qui tam provisions of the False...

Tagged in: Anti-Kickback and Stark, Electronic Health Records, FCA Federal, FCPA, Government Programs Fraud, Healthcare Fraud, Home Health and Hospice, Medicaid, Medicare, Pharma Fraud, Provider Fraud, Top 10,

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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,

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