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Whistleblowers Critical to Combat Electronic Health Records Fraud
A Synopsis of Will Powers’ Article in Medium.com on April 5, 2019
Medical organizations adopting electronic health records (EHR) technology have been awarded millions of dollars in grants to employ EHR software. Healthcare professionals who enter patients’ medical information using EHR software can defraud the federal government by manipulating the data entered, generating billions in inappropriate profits for themselves while putting patients at risk and wasting taxpayer dollars. Such fraud is primarily revealed by whistleblowers who can be compensated for their efforts.
The vendors who create the software, the certifying bodies who approve it and the healthcare providers (and their IT administrators) who use the software are all in a position to identify irregularities. Federal agencies conduct regular audits, as do in-house healthcare system auditors, but fraudulent schemes continue to be perpetuated. Some clues that fraud is occurring include an increase in reimbursements to a provider compared to when paper records were used, patient records which are continuously identical, such as the same weight and blood pressure at every exam, and glitches that occur when implementing routine software tasks such as split billing.
Large EHR software providers, including eClinicalWorks and Greenway Health LLC, settled with the U.S. Department of Justice in 2017 and 2018 respectively for more than $212 million for giving customers kickbacks to promote their software, for failing to comply with federal requirements, and for hiding said failures from certifying entities. The Federal False Claims Act (FCA) protects Whistleblowers from any type of retaliation. Whistleblower cases are filed under seal and remain secret. It is important for medical professionals at every level to monitor their systems for irregularities and fraud, as their first-hand knowledge is what makes a case viable, resulting in a critical saving of taxpayer money and patient lives.
If you are aware of an organization that is potentially defrauding public insurance 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 866-401-5971 if you would like more information.