The health care market is evolving. Physicians are becoming more specialized and patients are more likely to see many different providers. A single patient may have one doctor to manage diabetes, another to manage heart issues and still a third for problems with their joints. Technological advances have also worked to help better ensure physicians are aware of other treatments a patient may receive. In some cases, the government has even become involved.
How is the government involved in patient records? The government has encouraged health care providers to take part in Promoting Interoperability Programs, a program known in the past as The Medicare and Medicaid Electronic Health Records (EHR) Incentive Program. The program was designed to support providers as they transition to EHR systems.
Like any area of health care, there is significant oversight. The government has recently started to take note of fraud within this specific market.
What type of fraud is occurring within the EHR market? The Department of Justice (DOJ) recently accused a vendor of EHR software of fraud. The agency accused the vendor of submitting false claims for payment to Medicare and Medicaid Services and of paying illegal kickbacks to customers in exchange for recommending use of their products.
The prosecution gathered enough evidence to encourage the accused to agree to a settlement.
Based on the terms of the agreement, the vendor will not need to admit liability but will be required to pay $57 million in restitution. The DOJ released a statement along with the announced settlement, noting "EHR companies should consider themselves on notice" that the government will pursue allegations of False Claims Act violations involving EHR services.
This may be the beginning of a wave of similar cases. As a result, it is wise for EHR providers to review their current customer referral and marketing strategies for compliance with the Anti-Kickback Statute.