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Electronic Health Records

Another area that has been a focal point of the Department of Justice’s enforcement efforts is fraud involving electronic health records (EHR). 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.

The Department of Justice has obtained False Claims Act recoveries involving the misuse of electronic health records (EHR) software.

One vendor paid $145 MILLION relating to the misuse of its electronics health records software.

The health information technology developer allegedly made false representations to obtain a special certification for its software from the Government. The software developer concealed from the Government that the EHR 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 software could incorporate standardized vocabularies when it did not. These failures in the software caused eligible healthcare providers who used the EHR software to (unknowingly) falsely attest to compliance with HHS requirements necessary to receive Medicare incentive payments for using the software.

This is an example of where one company caused another company to submit a false claim even though the “submitting company” did not know the claim was false when they submitted the claim. As you can see, the False Claims Act is aimed at recovering all misspent money no matter who has caused the Medicare program to pay-out the 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 developer to include clinical alerts in its software that were designed to increase prescriptions for the drugs.

The Department of Justice is also interested in cases where vendors misrepresented the capabilities of their software, which in turn resulted in health care providers falsely obtaining incentive payments for software which did not perform the way it was supposed to perform.

Because the use of electronic health records by health care organizations and providers will continue to be used with more frequency, the Department of Justice said it expects to continue to see fraud schemes.

The Centers for Medicare and Medicaid Services (CMS) will also continue to use incentive payments to encourage health care organizations and providers to transition from paper to electronic health records (EHR). 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.

If you are aware of old, new, or evolving fraud schemes involving electronic health records (EHR), the Department of Justice may be very interested in learning more about the information you have. You may also be entitled to a financial reward. Tell us about the information you have at, and we will provide you a free consultation.

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