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Catch of the Week – EHR Developer Greenway Health to Pay $57.25 Million to Settle FCA Allegations

Posted  February 8, 2019

Electronic health records (EHR) software developer Greenway Health LLC agreed to pay $57.25 million to resolve allegations that it committed fraud by misrepresenting to its users the capabilities of its EHR product “Prime Suite” and by providing unlawful remuneration to users to induce them to recommend Prime Suite.

Under the American Recovery and Reinvestment Act of 2009, the government made incentive payments available to eligible healthcare providers that adopted certified EHR technology and met certain requirements relating to their use of the technology. The government alleged that Greenway was aware that a 2011 version of Prime Suite did not meet government-mandated requirements for incentive payments, but that Greenway did not tell its users about its failures or do anything to bring its product into compliance. As a result, numerous users of this 2011 version of Prime Suite falsely attested that they were eligible for EHR incentive payments when, in fact, they had not met all necessary use requirements.

The government also contends that Greenway falsely obtained certification for its 2014 edition of Prime Suite when it intentionally concealed from its certifying entity that Prime Suite did not fully comply with the requirements for certification. Greenway’s product allegedly did not incorporate the standardized clinical terminology necessary to ensure the reciprocal flow of information concerning patients and the accuracy of electronic prescriptions. Greenway allegedly accomplished its deception by modifying its test-run software to deceive the company hired to certify Prime Suite into believing that it could use the requisite clinical vocabulary.

The government also alleged that Greenway violated the Anti-Kickback Statute by paying money and incentives to its client providers to recommend Prime Suite to prospective new customers.

Assistant Attorney General Jody Hunt of the Department of Justice’s Civil Division stated, “electronic health records are critically important to the health care decision process, and both patients and providers rely on these technologies to safely and accurately record and transmit vital health information…[t]his resolution demonstrates our continued commitment to…promote public health while holding accountable those who seek to abuse the government’s trust.”

United States Attorney Christina E. Nolan for the District of Vermont added, “[i]n the last two years my office has resolved two matters against leading EHR developers where we alleged significant fraudulent conduct. These are the two largest recoveries in the history of this District and represent the return of over two-hundred and twelve million dollars of fraudulently-obtained taxpayer monies…[t]his resolution demonstrates my office’s initiative and resolve to vigorously uncover and to doggedly pursue these complex cases.”

As part of the settlement, Greenway entered into a five-year Corporate Integrity Agreement requiring, among other things, that Greenway retain an Independent Review Organization to assess Greenway’s software quality control and compliance systems and to review Greenway’s arrangements with health care providers to ensure compliance with the Anti-Kickback Statute. Greenway must provide prompt notice to its customers of any patient safety related issues and maintain on its customer portal a comprehensive list of such issues and any steps users should take to mitigate potential patient safety risks. Greenway must also allow Prime Suite customers to obtain the latest versions of Prime Suite at no additional charge, the opportunity to migrate their data from Prime Suite to another Greenway-developed software product also at no additional charge, and to give Prime Suite customers the option to have Greenway transfer their data to another EHR software vendor.

The government’s settlement with Greenway is one of the largest ever against an EHR developer in FCA history. As Ms. Nolan emphasized, “EHR companies should consider themselves on notice.”

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