Anyone working regularly with Electronic Health Record (EHR) software can spot fraud and abuse. In 2009, the federal government established the Medicare and Medicaid EHR Incentive Program that provided incentive payments to the healthcare providers that adopt certified EHR technology and meet certain requirements. In order for software companies to obtain certification for their product, they must meet all of the HHS testing and certification criteria.
While the federal government pushed for the adoption of EHR technology as a way to bring better health care for patients, the unfortunate truth is the adoption of EHR software has provided ample opportunity for large amounts of abuse and fraud. These abuses cost taxpayers money and, in some cases, can even put patients at serious risk of harm or death.
Spotting Fraud and Abuse
Whether you are a healthcare provider using EHR software or an IT professional responsible for maintaining, designing, or certifying the software, you can potentially spot and report fraud. Some common signs of EHR fraud are listed below:
- If the provider is receiving an overall greater reimbursement from government programs than they received using paper records
- If there are regular glitches in the system for routine tasks, such as split billing
- If notes in the patient records appear to be copy and pasted (i.e. consistently identical weight, blood pressure, etc.)
- If the EHR system is “hardcoded” to pass certification tests
- If financial compensation is paid for promoting the use of particular EHR software
- Also, be sure to trust your instincts. If something appears suspicious, make note and report it.
The Federal False Claims Act (FCA) protects whistleblowers from retaliation from their employers. This means the whistleblower cannot be fired, demoted or denied regular benefits in response or retaliation to reporting fraud. It is recommended that whistleblowers contact an attorney to ensure protection in these cases. When the Department of Justice finds evidence of fraud and pursues the case, the whistleblower typically receives a share of the settlement.
Contact Baron & Budd
If you are aware of an organization that is potentially defrauding public healthcare programs, including Medicare or Medicaid, you may qualify to serve as a whistleblower. If the allegations you bring to light are successfully prosecuted by the federal government, you may be entitled to a monetary reward. Please contact the Qui Tam lawyers at Baron & Budd or call us at if you would like more information.