Greenway Health LLC, a Tampa-based developer of electronic health records (EHR) software, recently agreed to pay $57.25 million to resolve False Claims Act (FCA) allegations that it overstated the capabilities of and failed to correct known errors with its EHR software.  In a complaint filed in the United States District Court for the District of Vermont, the United States alleged that Greenway caused its users to submit false claims to the government by, among other things, misrepresenting the capabilities of its EHR product “Prime Suite” and providing unlawful remuneration to users to induce them to recommend the product.

EHR Companies Must Be HHS Certified

The American Recovery and Reinvestment Act of 2009 established the Medicare and Medicaid EHR Incentive Program to encourage healthcare providers to adopt EHR technology and demonstrate its “meaningful use.”  To obtain certification for their product, EHR companies are required to demonstrate that their product satisfies all applicable U.S. Department of Health and Human Services (HHS) certification criteria.  This requires that developers do the following two things:

1. Pass testing performed by an independent, accredited testing laboratory authorized by HHS.
2. Obtain and maintain certification by an independent, accredited certification body authorized by HHS.

Greenway Obtained Certification in Deceptive Manner

In its complaint against Greenway, the government alleged the company falsely obtained certification for Prime Suite by concealing from the certifying entity the fact that Prime Suite did not fully comply with applicable certification requirements.  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.  However, Greenway hid this shortcoming by modifying its test-run software to deceive the certification company into believing that Prime Suite utilized the requisite clinical vocabulary.

Additionally, under the American Recovery and Reinvestment Act of 2009, healthcare providers were entitled to incentive payments if they met certain targets for EHR-related activities.  The government alleged that Greenway set up Prime Suite in a manner that caused certain users to falsely attest that they were eligible for EHR incentive payments.  As a result, numerous users of Prime Suite received EHR incentive payments when, in fact, they had not met all necessary use requirements.  Greenway allegedly knew this, yet failed to rectify the error.

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

The Greenway settlement adds to a staggering haul from EHR companies in the District of Vermont.  According to United States Attorney Christina E. Nolan, the district has recovered more than $212 million from EHR developers in the past two years.

For more information about this case or issues related to EHR software, subscribe to this blog or contact a member of the Bass, Berry & Sims Healthcare Fraud Task Force.