Department of Justice Targets Electronic Health Record (EHR) Fraud in 2020

Recently, Assistant Attorney General Jody Hunt spoke at a conference about the top target areas for False Claims Act enforcement in 2020. Hunt listed Electronic Health Record (EHR) fraud as one of the department’s top focus areas. Hunt said, “Given the critical and growing role that electronic health records play in our health care system today, we are expecting and anticipating…more of these cases in the future.” Fraud related to the health care industry made up a majority of the $3 billion the federal government recovered via enforcement actions in 2019.

The federal government has encouraged the implementation of Electronic Health Records (EHRs) to improve healthcare for patients across the country. EHRs are real-time, patient-centered records that make information available instantly and securely to patients and healthcare providers. In addition, EHRs can also go beyond standard clinical data to include a broader view of a patient’s care, including allowing access to tools that providers can use to make decisions about a patient’s care.

Recent EHR Fraud Cases

Some recent cases demonstrate DOJ’s appetite for increasing EHR fraud enforcement.

EHR providers have faced lawsuits for fraudulently obtaining certification for their software, knowing that it did not meet government standards. One of the nation’s largest EHR providers, eClinicalWorks, settled a lawsuit in 2017 with the U.S. Department of Justice for $155 million. The company concealed that its software did not meet the requirements for certification and also allegedly gave customers kickbacks for promoting its products.

Some EHR systems include “clinical decision support,” which gives doctors additional information about possible treatment options and medication options based on the data input by the physician. This technology is extremely helpful for doctors and patients; however, it has also created another avenue for fraud.

In January 2020, EHR company Practice Fusion agreed to pay $145 million to resolve criminal and civil charges that it accepted unlawful kickbacks from pharmaceutical companies. Practice Fusion took money from opioid manufacturers to manipulate data so the “clinical decision support” portion of its program would recommend doctors prescribe patients more opioids for treatment instead of other options.

Given DOJ’s recent comments, these settlements appear to be only the beginning of DOJ’s investigations into EHR fraud.

How You Can Help

Healthcare providers, IT professionals, coders, and other hospital employees are essential in combating EHR fraud. If you are aware of electronic healthcare record (EHR) fraud or have been approached with a proposal to commit fraud, you may qualify to serve as a whistleblower. Whistleblowers are protected by the law and can receive a portion of the recovery.

Baron & Budd’s experienced whistleblower representation team has helped numerous whistleblowers achieve a successful resolution in a wide variety of cases under state and federal law. Please call (866) 401-5971 if you want to report EHR fraud.

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