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EHR vendor Greenway will pay a stack of greenbacks to resolve fraud allegations

For the second time in two years an electronic health records vendor (EHR) will have to pay millions of dollars to fend off False Claims Act allegations. This time Tampa, Fla.-based Greenway Health is writing the check.
The basic outline of the case will be familiar to anyone who remembers the eClinicalWorks settlement.
I.   The Department of Justice (DOJ) accuses an EHR company of fibbing about its functionality to receive certification.
In its complaint, the government contends that Greenway falsely obtained 2014 Edition certification for its product Prime Suite when it concealed from its certifying entity that Prime Suite did not fully comply with the requirements for certification. 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. Greenway accomplished its deception by modifying its test-run software to deceive the company hired to certify Prime Suite into believing that it could use the requisite clinical vocabulary.
II.  Some of the alleged fibbing caused clinicians who used the software to improperly receive EHR incentive payments.
Additionally, in order to be eligible to receive incentive payments, healthcare providers were required to meet certain targets for EHR-related activities. For example, at certain times providers were required to provide patients with clinical summaries following office visits. In its complaint, the government further alleges that Greenway was aware that an earlier version of Prime Suite, which was certified to 2011 Edition criteria, did not correctly calculate the percentage of office visits for which its users distributed clinical summaries and thereby caused certain Prime Suite users to falsely attest that they were eligible for EHR incentive payments. Greenway refrained from rectifying this error in order to ensure that its users would receive incentive payments. As a result, numerous users of this earlier version of Prime Suite falsely attested that they were eligible for EHR incentive payments when, in fact, they had not met all necessary use requirements.
      a. In an added twist, the DOJ claimed Greenway violated the Anti-Kickback Statute by giving clients incentives to recommend its product. It remains to be seen whether clinicians who accepted inducements in exchange for recommendations will face legal consequences.
IV. The EHR company pays a steep settlement.
Greenway Health LLC (Greenway), a Tampa, Florida-based developer of electronic health records (EHR) software, will pay $57.25 million to resolve allegations in a complaint filed by the United States under the False Claims Act alleging that Greenway caused its users to submit false claims to the government by misrepresenting the capabilities of its EHR product “Prime Suite” and providing unlawful remuneration to users to induce them to recommend Prime Suite, the Justice Department announced today.
V.  The EHR company enters into a corporate integrity agreement (CIA).
This innovative five-year CIA requires, among other things, that Greenway retain an Independent Review Organization to assess Greenway’s software quality control and compliance systems and to review Greenway’s arrangements with health care providers to ensure compliance with the Anti-Kickback Statute.
      a. The settlement includes protections for clinicians who want to cut their ties with Greenway.
Greenway must provide prompt notice to its customers of any patient safety related issues and maintain on its customer portal a comprehensive list of such issues and any steps users should take to mitigate potential patient safety risks. The CIA also requires Greenway to allow Prime Suite customers to obtain the latest versions of Prime Suite at no additional charge, the opportunity to migrate their data from Prime Suite to another Greenway-developed software product also at no additional charge, and to give Prime Suite customers the option to have Greenway transfer their data to another EHR software vendor without penalties, service charges, or any other fees other than contractual amounts still owed in connection with goods or services already provided.
Checking up on EHR incentive payments has been in the HHS Office of Inspector General's (OIG) Work Plan few years, and an audit report published June 2017 revealed that Medicare had paid an estimated $729 million in inappropriate incentives. So it may be these settlements will become more frequent as investigators continue to dig.
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