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How electronic health records are leading to fraud investigations

| Jan 30, 2020 | White Collar Offenses |

Electronic health record (EHR) software was designed to keep patients safer. Aside from just eliminating problems with clarity and readability in handwritten medical records, EHRs were supposed to make it easy for physicians to coordinate patient care with other providers and avoid serious medical errors while diagnosing or treating patients.

The problem is that many of them didn’t work. Doctors, hospitals and whistleblowers alike have filed lawsuits over the issue, claiming that many of the companies pushing their software have flat out lied to the government. Three major EHR providers have already cut deals with the Justice Department to pay back $357 million in federal subsidies to end both civil and criminal claims against them. Two others (at least) are still being investigated.

But EHR software vendors aren’t the only ones in trouble. Federal authorities are looking into doctors and hospitals that also claimed subsidies for their EHR systems. Roughly 28% of the doctors and 5% of the hospitals investigated failed compliance audits. As of the end of 2019, the government had used its power to claw back $941 million worth of subsidies.

As one senior counsel employed by the Department of Health and Human Services, Office of Inspector General (DHHS, OIG) stated, “We’re entering an entirely new area of health care fraud.”

Whether you’re part of a company that provides electronic health record systems or a doctor whose practice has accepted government subsidies for using them, the new focus on this issue should serve as a warning. If investigators land on your doorstep, take the issue seriously and assume that the government may aggressively pursue health care fraud charges. The current social and political attention on rising medical costs in this nation has made issues involving health care fraud extremely high-profile.

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