Do you work in the healthcare industry or for an Electronic Health Record (EHR) software company? Do you have information about a fraudulent scheme being perpetuated? Perhaps they are paying or receiving kickbacks in exchange for using certain EHR software. So, what should you do next? It is important to first seek the guidance of an experienced whistleblower attorney. A whistleblower attorney will meet with you to discuss your potential case and determine the best way to present the inside information you have to the federal government. If you qualify to be a whistleblower, you are afforded certain protections by federal law. Your whistleblower attorney will help ensure your protections in these cases. Whistleblowers may also be entitled to a share of any monetary recovery by the government because of the fraud.

About Electronic Health Records (EHR) Fraud

All EHR fraud is not the same, but a recent case showcases common fraudulent EHR schemes. Modernizing Medicine Inc. (ModMed), an EHR technology vendor, agreed to pay $45 million to resolve allegations that it violated the False Claims Act (FCA) by first, accepting and providing unlawful renumeration in exchange for referrals, and second, by causing its users to report inaccurate information on claims for federal incentive payments. This settlement was made possible by a former Vice President of Product Management at ModMed, who filed a lawsuit under whistleblower provisions of the FCA. For her role in bringing forward a successful suit, the whistleblower received approximately $9 million of the settlement.

ModMed allegedly took part in three illegal marketing programs with another firm, Miraca Life Sciences Inc. These marketing programs included ModMed soliciting and receiving kickbacks in exchange for recommending and arranging for ModMed’s users to utilize Miraca’s pathology lab services. ModMed also conspired with Miraca to improperly donate ModMed’s EHR to health care providers with the aim of increasing lab orders to Miraca while simultaneously adding customers to ModMed’s user base. And finally, ModMed also paid kickbacks to its current health care provider customers and other influential sources in the healthcare industry to recommend ModMed’s EHR and refer potential customers to ModMed.

In addition, DOJ alleged ModMed abused the 2009 Medicare and Medicaid Electronic Health Records (EHR) Incentive Program. This program was initially established to provide better healthcare to patients and reduce healthcare costs by encouraging healthcare providers to move away from paper records and to adopt EHR technology. Software companies who obtain certification by showing their EHR software satisfies U.S. Department Health and Human Services (HHS) criteria can be eligible for government-subsidized payments on behalf of health practices. The settled case alleged that ModMed illegally took advantage of HHS’ EHR Incentive Program when it misrepresented that its EHR technology met the agency’s standards, thereby falsifying its eligibility for incentive payments. The certification requirements mandated ModMed’s technology utilize certain standard vocabularies for drugs and clinical terminology. ModMed, however, failed to include this functionality, thereby rendering their EHR technology effectively useless because physician users could not electronically record medical records using the required standard vocabularies. Thus, claims for incentive payments under the HHS program were not valid.

ModMed is just one of many alleged cases of EHR fraud. Ultimately, when EHR systems don’t meet the proper criteria for certification, it can create safety issues for patients such as failure to perform the most basic tasks like linking the correct medical record to the correct patient. Kickbacks related to EHR systems also risk corrupting medical decision making and can result in patient harm. Additionally, such foul play increases costs to patients and steers federal funding away from firms who play by the rules. This is why the federal government is calling on whistleblowers to step forward to help end EHR fraud. Whistleblowers can be anyone – whether an individual from the doctor’s office or hospital who uses the EHR system, to someone at the software company who designs and implements the software, or someone at the certification company who learns the EHR software doesn’t work the way it’s supposed to. Most importantly, the False Claims Act protects whistleblowers from retaliation and provides financial incentives for individuals that come forward with evidence of EHR fraud.

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With more than 30 years of experience, the attorneys on Baron & Budd’s whistleblower representation team have represented dozens of clients in government fraud cases returning over $6.0 billion to federal and state agencies, with whistleblower recovery shares as high as 49%. They are ready to help if you have evidence of fraud involving the WOSB Program.

Please call (866) 845-2164 or complete our contact form if you would like more information. For more information, see What You Need to Know About Becoming a Whistleblower. Please understand that contacting us does not mean that you have established an attorney-client relationship with Baron & Budd, P.C.