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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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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...

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...

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

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...

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

Top Takeaways from Former DOJ Civil Chief Jody Hunt on the Current State of False Claims Act Enforcement

Posted  08/28/20
department of justice website
Law360 recently interviewed former DOJ Civil Chief Jody Hunt on what he sees as the key issues surrounding False Claims Act enforcement these days.  Here are the top takeaways:
    • COVID-relief fraud will be a DOJ priority. No surprise there given the billions of dollars the federal government is pouring into the economy to alleviate some of the financial strain the pandemic is wreaking on healthcare providers...

DOJ Discusses Its 2020 Healthcare Fraud Enforcement Priorities

Posted  03/6/20
By Michael Ronickher
DOJ Headquarters building seen from low angle
In comments at the 2020 FBA Qui Tam conference, the Department of Justice reaffirmed its strong commitment to pursuing fraud under the False Claims Act and emphasized its particular focus on rooting out healthcare fraud. Jody Hunt, Assistant Attorney General in the Civil Division of DOJ, was encouragingly forceful in his comments about the critical role of the FCA in protecting the public fisc—and the patient...

Catch of the Week: Practice Fusion Pays $145 Million for EHR Kickbacks and Misrepresentations about Software

Posted  01/28/20
Healthcare providers talk about the importance of behavioral “nudges” – gentle pushes to encourage healthy choices and positive behaviors. In our Catch of the Week, healthcare providers were nudged to prescribe highly addictive extended-release opioids in a manner that was not consistent with accepted medical standards. Who nudged them? Their own electronic health records system, which was paid to do so by the...

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

Top Ten Healthcare Fraud Recoveries of 2019

Posted  01/24/20
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 again, most of the funds recovered arose from cases originated by whistleblowers under the qui tam provisions of the False Claims Act.  Not surprisingly, seven of the top ten spots in our list involved false claims act lawsuits against drug companies...
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