EHR Vendor to Pay $57.25 Million For False Claims Act Violation

Greenway Health LLC, an electronic health record (EHR) software developer based in Tampa, FL, has agreed to pay $57.25 million to the Department of Justice to settle violations of the False Claims Act.

The DOJ alleged that Greenway Health misrepresented the capabilities of its EHR product Prime Suite, which resulted in users of the software submitting false claims to the U.S. government. Additionally, Greenway Health was alleged to have offered illegal payments to users to encourage them to recommend the EHR product to other healthcare companies.

The U.S. government gave incentives to healthcare providers to encourage them to change from paper records to EHRs through the Meaningful Use program. the majority of healthcare providers have now transitioned to EHR systems and depend on them to when making healthcare decisions. It is consequently important that EHR products record and transmit patient health data accurately.

Healthcare providers were only eligible to receive Meaningful Use payments if they used EHR products that the Department of Health and Human Services (HHS) has certified as satisfying certain criteria. To be certified, an independent testing laboratory accredited by the HHS was required to test the EHR products. if they were confirmed as meeting HHS criteria, an official certification body issued certification.

Greenway Health was alleged to have falsely acquired Prime Suite’s 2014 Edition certification by hiding the fact that the product did not comply with all the criteria set by HHS, which included using standardized clinical terminology to ensure the reciprocal flow of patient data and the reliability of electronic prescriptions. Allegedly, Greenway Health altered its test-run software program to fool the firm that certified Prime Suite into thinking it utilized the required clinical vocabulary.

Healthcare organizations using Prime Suite had to meet targets for EHR-associated activities in order to obtain Meaningful Use incentive payments. One target was to give clinical summaries to a specific percentage of patients after office appointments. The 2011 Edition of Prime Suite didn’t correctly compute the percentage of office appointments for which users submitted clinical summaries which resulted in some providers submitting false claims. The error was not corrected by Greenway Health because by doing so its users would not qualify for Meaningful Use incentive payments. Greenway Health was also alleged to have violated the Anti-Kickback Statute by offering financial incentives to users who recommend Prime Suite to other healthcare providers.

Besides the financial penalty, Greenway Health also agreed to a 5-year Corporate Integrity Agreement (CIA) with the HHS’ Office of Inspector General. As per the CIA, an Independent Review Organization must assess Greenway Health’s software quality control and compliance systems, including its arrangements with healthcare companies, and ensure compliance with the Anti-Kickback Statute.

Greenway Health also needs to let all Prime Suite users upgrade to the latest version of the product at no additional cost. If its customers want to transfer their information to a different EHR software provider, they must be allowed to do so without incurring a penalty or service charge.

This case shows the commitment of the Department of Justice’s Civil Division to pursue EHR vendors who misrepresent the functionality of their EHR solutions. The DOJ is determined to promote public health and hold the companies that abuse the government’s trust to account. Greenway Health is the second EHR provider that was charged with concealing product failures in the last two years. eClinicalWorks settled its case for $155 million.