EHR Whistleblower Lawyer
Learn What You Need to Know About Serving as an Electronic Health Records (EHR) Whistleblower
While electronic health records (EHR) are ubiquitous in modern healthcare practice, this wasn’t always the case. At the dawn of the EHR industry, the idea of keeping electronic charts was novel, and relying on electronic health record vendors to protect patients’ sensitive information posed unprecedented risks.
As a result, Congress legislated heavily around the use of EHR software—and this legislation remains in place today. In particular, the Health Information Technology for Economic and Clinical Health Act (HITECH Act) establishes stringent requirements regarding medical providers’ use of EHR technology, and medical providers that fail to meet these requirements can face steep penalties.
Whistleblowers Play a Key Role in Exposing EHR Violations Within the Healthcare Industry
But, to hold specialty medical practices and other healthcare providers accountable, the federal government needs to know that enforcement action is warranted. This is where EHR whistleblowers come into play.
We represent EHR whistleblowers nationwide. This includes both whistleblowers in the healthcare services industry and whistleblowers in the electronic medical records industry. Whether you work for a specialty medical practice, hospital, clinical laboratory, diagnostic testing business, one of the major pharmaceutical companies, or one of the many software developers that offer EHR programs, our EHR whistleblower lawyers can help you make an informed decision about coming forward. If you decide to come forward, our lawyers can file a qui tam complaint on your behalf, and we can work with the government to secure your whistleblower award if you become eligible to receive one.
Reporting EHR Fraud to the Federal Government
Our lawyers help whistleblowers report all forms of EHR fraud to the federal government. If you have information about any of the following forms of EHR fraud—or any other form of EHR fraud—we strongly encourage you to contact us for a free and strictly confidential consultation:
Anti-Kickback Statute Violations Involving EHR Vendors
The federal Anti-Kickback Statute prohibits healthcare providers and other entities from using Medicare or Medicaid funds to pay for referrals. It also applies to offering, soliciting, and accepting illegal referral fees, and it allows for both criminal and civil charges depending on the specific allegations at issue. Hospital employees and other whistleblowers can report a wide range of prohibited financial relationships involving EHR technology under the Anti-Kickback Statute.
Billing Fraud Involving Electronic Medical Records
Whistleblowers can also report billing fraud involving electronic health record systems. When healthcare providers illegally prioritize profits over patient care and patient safety, they can—and should—be held accountable. We help EHR whistleblowers expose all forms of billing fraud, from fraudulent claims regarding certification testing to unbundling, upcoding, and other common healthcare billing violations.
EHR System Certification Fraud
EHR systems are subject to strict certification requirements under federal law. If a healthcare provider uses non-certified EHR technology, if a provider or developer falsely claims to meet the federal certification criteria, or if any entity engages in any other form of EHR system certification fraud, these can all serve as clear grounds for filing an EHR whistleblower complaint.
EHR System Deficiencies and Failures
Along with certification-related violations, healthcare providers and other entities can be held accountable for various other types of EHR system deficiencies and failures as well. The standards that are in place are designed to protect patients and their confidentiality, and violations of any of these standards can warrant whistleblower complaints and federal enforcement action.
Fraudulently Claiming EHR Incentive Payments
Medical professionals and healthcare entities can also be held liable for fraudulently claiming EHR incentive payments. If any medical professional or healthcare entity receives EHR incentive payments when it is ineligible to do so, this constitutes federal fraud, and a federal whistleblower complaint will generally be warranted.
Improper Use of EHR Clinical Decision Support
Improper use of EHR clinical decision support to drive diagnostic testing business or to provide treatments that are not medically necessary can warrant a federal whistleblower complaint as well. If you have reason to believe that your employer (or another healthcare provider) is improperly using EHR clinical decision support functionality to overbill the federal government, we want to hear from you.
Meaningful Use Fraud
To qualify for federal incentive payments, healthcare providers must make “meaningful use” of their EHR systems. If a healthcare provider is claiming to make “meaningful use” of its EHR system when it is not meeting the applicable federal requirements, this can provide clear grounds to file an EHR whistleblower complaint as well.
Blowing the Whistle on EHR Fraud Under the False Claims Act
Blowing the whistle on EHR fraud generally involves coming forward under the federal False Claims Act. The False Claims Act is a powerful anti-fraud law that covers all of the forms of EHR fraud discussed above.
When healthcare providers and other entities submit false claims that result in improper payments under Medicare and Medicaid (among other federal healthcare programs), False Claims Act cases initiated by whistleblowers allow the government to recover taxpayers’ losses. The definition of “false claims” is extremely broad—essentially all forms of EHR fraud can warrant cases against the healthcare provider(s) or other entity(ies) involved.
Eligibility for EHR Whistleblower Rewards
Whistleblowers who help the federal government hold healthcare providers and other entities accountable for EHR fraud may be eligible to receive monetary rewards under the False Claims Act. Rewards in False Claims Act cases generally range from 15% to 30% of the monetary penalties recovered. This is true whether the government resolves allegations against the targeted entity via settlement or successfully pursues a civil or criminal enforcement action in federal court.
A key factor in determining EHR reward amounts is the government’s decision regarding intervention. Filing a whistleblower complaint under the False Claims Act involves filing a qui tam lawsuit on the government’s behalf. If the government decides to intervene in your lawsuit, your potential reward amount will generally range from 15% and 25% of the amount recovered (if any). If the government decides not to intervene and you successfully pursue a lawsuit on the government’s behalf, you will generally be entitled to between 25% and 30% of the amount recovered.
FAQs: Serving as an EHR Whistleblower
How Has Modernizing Medicine with EHR Contributed to an Increase in Billing Fraud?
Modernizing medicine with electronic health records (EHR) has contributed to an increase in billing fraud in several ways. In many respects, it is now easier for healthcare providers to make mistakes—and, while these mistakes may not warrant criminal prosecution, they still constitute billing fraud under federal law.
Some healthcare providers use their EHR systems to perpetrate intentional billing fraud schemes as well. From knowingly using noncompliant EHR systems to programming clinical decision support capabilities to falsely support medically unnecessary services, intentional billing fraud involving EHR systems can take many different forms.
When Can Healthcare Providers Be Held Accountable for Electronic Health Records Fraud?
Healthcare providers can be held accountable for electronic health records (EHR) fraud whenever they bill the federal government while in noncompliance with the federal EHR requirements. Again, this noncompliance can take many different forms, and it is often up to whistleblowers to inform the federal government that enforcement action is warranted. Healthcare fraud costs taxpayers tens of billions of dollars annually—and EHR-related fraud accounts for a significant portion of this total.
How Do I File a Whistleblower Complaint Against a Healthcare Provider or EHR Company?
Filing a whistleblower complaint against a healthcare provider or EHR company generally involves coming forward under the False Claims Act. This is a formal legal process that requires strict compliance with all applicable federal requirements. As a result, healthcare employees and other individuals will generally need to work with an experienced EHR whistleblower lawyer who can help them come forward effectively.
What Is Involved in Filing a Whistleblower Lawsuit Under the HITECH Act?
Violations of the Health Information Technology for Economic and Clinical Health Act (HITECH Act) will support whistleblower complaints under the False Claims Act in many cases. If you have information about a healthcare provider improperly billing the federal government for EHR incentive payments or using EHR to improperly bill Medicare or Medicaid, for example, you may be eligible to come forward under the False Claims Act. Our attorneys can explain everything you need to know.
Do I Need a Whistleblower Attorney to Report EHR Fraud to the Federal Government?
While not legally required, hiring a whistleblower attorney to help you report EHR fraud to the federal government is strongly recommended. If you are thinking about serving as an EHR whistleblower, our attorneys can help you make an informed decision; and, if you decide to come forward, we can represent you at no out-of-pocket cost.
Speak with an Experienced EHR Whistleblower Attorney in Strict Confidence
Do you need to know more about serving as an EHR whistleblower? If so, we invite you to get in touch. To speak with an experienced EHR whistleblower attorney in strict confidence as soon as possible, call us at 888-680-1745 or tell us how we can contact you online today.