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Electronic Health Records Fraud

Electronic Health Record Fraud Whistleblower Lawyer

Fraud involving electronic health records (EHR) is a focal point of the Department of Justice’s enforcement efforts. Providers increasingly rely on electronic health records to provide vital and unbiased information to improve treatment outcomes for patients. While electronic software is intended to reduce errors and improve the delivery of care, the transition to an electronic format has also introduced new opportunities for fraud and abuse.

If you have knowledge of active healthcare fraud taking place, let the electronic health record fraud whistleblower lawyers at Tycko & Zavareei LLP help you expose fraudulent activity in a qui tam lawsuit.

What is an EHR?

An electronic health record is a digital chart of a patient’s medical history. EHR systems give medical staff instant access to the most up-to-date patient records, orders, histories, lab results, medications, and more. They are also portable and can be shared with other providers as needed, which makes information more available and improves overall record keeping. Finally, EHR platforms use the data entered by medical staff to attach diagnostic and procedure codes, thereby streamlining billing processes.

Risks of Poor EHR Systems

Poor EHR systems can endanger patients. For instance, inaccurate medication records could cause patients to suffer adverse side effects and drug interactions. Examples of medication record inaccuracies include dosage errors and unreported adverse drug interactions.

Additionally, bugs in an EHR system, poor system interfaces, or software incompatibilities can lead to critical results going largely unreported, inaccurate information being recorded, and incorrect orders being given. Furthermore, EHR platforms that are programmed to warn about small errors may create warnings about every minuscule error, leading physicians to develop “error fatigue,” which then creates conditions where important updates or information are easily overlooked.

What is Electronic Health Records Fraud?

Electronic health records fraud often occurs when a health information technology company lies about the capabilities of its EHR software in order to receive government certification that it meets U.S. Department of Health and Human Services (HHS) requirements. Healthcare providers may then unknowingly claim their EHR platform meets eligibility requirements for Medicare and Medicaid reimbursement. The Centers for Medicare and Medicaid Services (CMS) uses incentive payments to encourage healthcare organizations and providers to transition from paper to electronic health records.

Specifically, Medicare’s EHR Incentive Program requires healthcare providers to show “that they are using their EHRs in ways that can positively affect the care of their patients.” In other words, the Medicare EHR Incentive Program requires providers to “demonstrate meaningful use of their EHRs [to] receive an incentive payment.”

Providers may knowingly or unknowingly submit false information about how they use their EHR system or what their EHR platforms do in order to meet all of the requirements established by CMS for this program. When EHR vendors and healthcare providers use fraudulent means to secure incentive payments from the government, they can be held accountable in a qui tam lawsuit filed with the help of an electronic health record fraud whistleblower attorney.

Types of Electronic Health Records Fraud

Healthcare providers and healthcare software companies may commit electronic health records fraud in several ways. First, they may be on the hook for EHR fraud when they submit false claims to the Centers for Medicare and Medicaid Services for incentive payments to which they are not entitled. They may do so by misrepresenting their usage of the EHR system or its functions on a claim for Medicare incentive payments.

Healthcare technology companies may also obtain fraudulent certifications despite knowing that their EHS system does not meet the Department of Health and Human Services’ standards. Some EHR vendors even create special versions of their software intended to meet Medicare’s certification requirements, while the software that is actually implemented for providers to use functions totally differently.

EHR Systems and Illegal Kickbacks

EHR systems typically have clinical decision support (CDS) alerts or prompts that encourage physicians to recommend certain prescriptions, healthcare services, or referrals. Pharmaceutical companies may pay EHR companies to gain advertising placement in their systems and, therefore, more revenue from clinicians who may be swayed by the advertising. EHR vendors may also provide some type of illegal incentive or “kickback” to entice healthcare workers to recommend and purchase their systems.

EHR systems may also be used to facilitate healthcare fraud. Programs can be designed to manipulate clinicians into ordering unnecessary tests, prescribing more expensive drugs, or overbilling Medicare or Medicaid, all of which are violations of the False Claims Act.

Examples of Electronic Health Records Fraud

The Department of Justice has obtained False Claims Act recoveries involving the misuse of EHR software. One vendor paid $145 million relating to the misuse of its electronic health record system.

The health information technology developer allegedly made false representations to obtain a special certification for its EHR software from the government. The software developer concealed from the government that the software did not comply with all of the applicable requirements for certification in two ways.

First, it falsely stated that it could meet what is called a “data portability” requirement when it could not. The developer also claimed that its electronic health records software could incorporate standardized vocabularies when it could not. These false statements led eligible healthcare providers who used the EHR software to (unknowingly) falsely attest to compliance with HHS requirements needed to receive Medicare reimbursement for using it.

This is an example of one company causing another to submit a false claim even though the “submitting company” did not know the claim was false when submitting it. The False Claims Act is an avenue for recovering all misspent money regardless of who caused the Medicare program to pay-out money that it otherwise should not have paid.

In another scheme involving electronic health records, a pharmaceutical company was liable under the False Claims Act for paying kickbacks to a health information technology developer in exchange for the inclusion of clinical alerts in its software that were designed to increase prescriptions for drugs.

What Should I Do if I Am Aware of Electronic Medical Records Fraud?

If you are aware of electronic medical records (EMR) fraud, you should consult with an attorney as soon as possible to learn more about your options. The Department of Justice is interested in cases where vendors misrepresented the capabilities of their EMR systems, which in turn resulted in healthcare providers falsely obtaining incentive payments for software that did not perform the way it was supposed to.

Because the use of electronic health records by healthcare organizations and providers will continue to be used with more frequency, the Department of Justice said it expects to continue to see fraud schemes involving electronic health record systems. As a result, we expect to see more of these cases, and we expect the Department of Justice will need to have individuals point them in the right direction of developing fraud schemes.

Get in touch with Tycko & Zavareei LLP today to speak with a dedicated electronic healthcare fraud whistleblower lawyer. We can help you become a whistleblower and offer assistance throughout the process of filing a qui tam lawsuit.

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