Whistleblowers Allege FCA Violations in $324 Million Lawsuit Involving 62 Indiana Hospitals.

Date posted: January 2, 2018

A recently unsealed qui tam (whistleblower) lawsuit alleges that 62 Indiana hospitals and a Georgia-based health IT company violated the federal False Claims Act.  In one allegation, the lawsuit stated that the hospitals submitted false claims to obtain federal grant money available under the Health Information Technology for Economic and Clinical Health (HITECH) Act.  These organizations allegedly falsified Meaningful Use attestation data to obtain more than $324 million in electronic health record (EHR) incentive payments.  Under the Meaningful Use requirements, hospitals may prove their healthcare compliance with core measures using attestations and reports.  Core measure 11, EHR fulfillment, requires entities to prove that they have provided patients with their EHR upon request at least 50 percent of the time, and in a timely manner, to receive the incentive payments.  The whistleblower suit alleges that the practice of misreporting EHR fulfillment is widespread in the state.  The primary party in the case is Georgia-based Ciox Health, which claims to serve 60 percent of U.S. hospitals and more than 16,000 physicians.  The alleged scheme involved paying kickbacks by overbilling for the release of electronic medical records.  The Department of Justice declined to intervene in the lawsuit.

The HITECH Act created grant funding for hospitals that voluntarily participated in a program to encourage the use of electronic medical record systems.  The law also included a statute that gave all Americans the right to obtain their electronic medical records from hospitals in an easy and inexpensive manner.  To receive this grant funding, the Indiana hospitals agreed to track, report, and provide access to electronic medical records at patients’ requests.

The full court complaint is available at:

https://s3.amazonaws.com/assets.fiercemarkets.net/public/004-Healthcare/external_Q42017/USvMemorial.pdf

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