Electronic health records vendor pays $57.25 million to resolve kickback, false claims allegations

by Ben Vernia | February 18th, 2019

On February 6, the Department of Justice announced that Tampa-based Greenway Health, LLC, the maker of electronic health records software, will pay $57.25 million to resolve allegations that the company’s software caused the submission of false claims by health care providers which used it, and that the company offered unlawful inducements for the use of its products. According to DOJ’s press release:

Greenway Health LLC (Greenway), a Tampa, Florida-based developer of electronic health records (EHR) software, will pay $57.25 million to resolve allegations in a complaint filed by the United States under the False Claims Act alleging  that Greenway caused its users to submit false claims to the government by misrepresenting the capabilities of its EHR product “Prime Suite” and providing unlawful remuneration to users to induce them to recommend Prime Suite, the Justice Department announced today.

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The American Recovery and Reinvestment Act of 2009 established the Medicare and Medicaid EHR Incentive Program to encourage healthcare providers to adopt and demonstrate their “meaningful use” of EHR technology.  Under the program, the U.S. Department of Health and Human Services (HHS) made incentive payments available to eligible healthcare providers that adopted certified EHR technology and met certain requirements relating to their use of the technology.  To obt ain certification for their product, companies that develop and market EHR technology are required to demonstrate that their product(s) satisfies all applicable HHS-adopted certification criteria.  Developers must first pass testing performed by an independent, accredited testing laboratory authorized by HHS, and then obtain and maintain certification by an independent, accredited certification body authorized by HHS.

In its complaint, the government contends that Greenway falsely obtained 2014 Edition certification for its product Prime Suite when it concealed from its certifying entity that Prime Suite did not fully comply with the requirements for certification.  Among other things, Greenway’s product did not incorporate the standardized clinical terminology necessary to ensure the reciprocal flow of information concerning patients and the accuracy of electronic prescriptions.  Greenway accomplished its deception by modifying its test-run software to deceive the company hired to certify Prime Suite into believing that it could use the requisite clinical vocabulary.

Additionally, in order to be eligible to receive incentive payments, healthcare providers were required to meet certain targets for EHR-related activities.  For example, at certain times providers were required to provide patients with clinical summaries following office visits.  In its complaint, the government further alleges that Greenway was aware that an earlier version of Prime Suite, which was certified to 2011 Edition criteria, did not correctly calculate the percentage of office visits for which its users distributed clinical summaries and thereby caused certain Prime Suite users to falsely attest that they were eligible for EHR incentive payments.  Greenway refrained from rectifying this error in order to ensure that its users would receive incentive payments.  As a result, numerous users of this earlier version of Prime Suite falsely attested that they were eligible for EHR incentive payments when, in fact, they had not met all necessary use requirements

Finally, the government also alleged that Greenway violated the Anti-Kickback Statute by paying money and incentives to its client providers to recommend Prime Suite to prospective new customers.

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The case apparently arose from a governmental investigation, and not a whistleblower’s lawsuit.

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