Electronic Health Record Fraud and Abuse

In 2009, the American Recovery and Reinvestment Act launched the Medicare and Medicaid Electronic Health Records (EHR) Incentive Program as a way to encourage healthcare providers to adopt EHR technology. The EHR systems aimed to bring better healthcare to patients and reduce health care costs.

The incentive program helped jumpstart what is now the widespread adoption of EHRs. However, this proliferation of EHR technology has led to opportunities for fraud and abuse. EHR fraud is wide-ranging and comes in many different forms. For example, an investigation by the Department of Health and Human Services found nearly three-quarters of a billion dollars was paid out to health care providers who were not qualified to receive the money.

Who Can Help?

There are three types of organizations or individuals that create or manage EHR systems: software companies, healthcare providers, and the Accredited Test and Certification Body (ONC-ATCB). Any of these individuals who work closely with EHR software can help detect fraud.

Detecting and Reporting Fraud

Whether you are a staff member in a health clinic or an IT employee responsible for maintaining EHR systems, you can look for signs for EHR fraud and report suspicious activity. Whistleblowers are often times the only way EHR fraud is reported.

Some red flags to look for that may be an indication of fraudulent activity are: providers receiving greater reimbursement from the government than before they adopted EHR technology, patient records that have been copy/pasted (i.e. same height, weight, blood pressure, etc.), and consistent glitches with everyday tasks, such as split billing. Furthermore, financial arrangements where EHR companies receive payments from pharmaceutical manufacturers to promote certain drugs through EHR software or healthcare providers receive financial incentives from EHR companies to buy or promote that company’s EHR software can be illegal kickbacks.

Be sure to trust your instincts. If something appears suspicious, make note and report it.

Our Team

With over 30 years of experience in Qui Tam cases, the attorneys on Baron & Budd’s whistleblower representation team have represented some 70 clients in government fraud cases returning over $5.4 billion to federal and state agencies, with whistleblower recovery shares as high as 49%. They are ready to help if you have evidence of fraud involving electronic health records.

Please call (866) 432-2203 or complete our contact form if you would like more information. For more information, see What You Need to Know About Becoming a Whistleblower.  Please understand that contacting us does not mean that you have established an attorney-client relationship with Baron & Budd, P.C.”