Today, the national law firm Baron & Budd announced that it is dedicating significant resources from its whistleblower practice to investigate allegations of Electronic Health Records (EHR) fraud. To combat EHR fraud, help from individuals with inside information is needed.
“In many cases the only way fraud is discovered is when a whistleblower comes forward with information,” said Baron & Budd attorney, Will Powers. “Identifying and stopping EHR fraud is extremely important. EHR fraud schemes not only defraud taxpayers but puts the health and safety of patients at risk.”
EHR software is used by healthcare professionals to deliver better patient care by tracking patient data like medications, test results, medical history, and other personal information. EHR fraud can happen in many different ways but two schemes have been at the forefront of government enforcement.
The first major way EHR fraud occurs is certification fraud. The federal government has dedicated billions of dollars to be used as incentive payments for healthcare providers to adopt and use EHR software in their practices. But before it can be eligible for government incentive payments, an EHR software vendor must meet certain requirements and criteria determined by the U.S. Department of Health and Human Services (HHS). Companies commit EHR fraud when they misrepresent the capabilities of their systems to obtain government certification.
The second major EHR fraud scheme is EHR companies paying illegal kickbacks to induce healthcare providers to use their software. Providing kickbacks to healthcare professionals in exchange for their use of certain EHR software is strictly prohibited under laws like the Anti-Kickback statute. Illegal kickbacks can take many forms, but at the most basic level, are anything of value used to induce purchase of a particular EHR system. Illegal EHR kickbacks have been things such as tickets to sporting events, referral bonuses, and rebate or discount deals.
When EHR systems do not 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. EHR kickback cases also risk corrupting medical decision making that can result potential patient harm – not to mention the kickbacks resulting in increased costs to patients and the government.
Recent enforcement actions have shown that DOJ is willing to aggressively prosecute EHR fraud in its many forms, but DOJ cannot do it alone. Whistleblowers who have information that their employer or competitors are manipulating EHR software to falsify certifications or paying out kickbacks to medical professionals may bring lawsuits under the False Claims Act (FCA). The FCA allows whistleblowers to receive a portion of the money recovered by the government if the case results in a settlement or a successful verdict.
If you are aware of EHR fraud, please contact the whistleblower attorneys at Baron & Budd to discuss your potential case. For more information about whistleblower cases, visit www.becomeawhistleblower.com.
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