EHR Whistleblower Award

Electronic Health Record (EHR) Whistleblowers May Be Eligible for Awards Under the Federal False Claims Act

Eligible whistleblowers who report fraud involving government healthcare programs can receive awards under the federal False Claims Act. Unfortunately, fraud is pervasive in all segments of the healthcare industry, and this includes fraud involving electronic health records (EHR). From using EHR to substantiate fraudulent billings to falsely claiming to use certified EHR technology, EHR fraud can take many different forms. Whistleblowers can expose all forms of EHR fraud—and they can receive a financial reward in many cases.

While the federal government is committed to holding healthcare providers accountable, it relies heavily on whistleblowers to report fraud under the False Claims Act. We help employees (and former employees) of medical providers, EHR vendors, and other companies come forward and seek financial rewards when warranted.

EHR Whistleblower Rewards Under the False Claims Act

The Health Information Technology for Economic and Clinical Health Act (HITECH Act) establishes the federal standards that hospitals, clinicians, and other healthcare providers must follow when using EHR systems and relying on electronic medical records for billing and healthcare decision-making. If a violation of the HITECH Act results in improper billings under Medicare, Medicaid, or any other federal healthcare program, this can warrant a whistleblower claim under the False Claims Act.

Along with healthcare providers, EHR companies and other entities involved in the electronic medical records industry can be held accountable under the False Claims Act as well. In all cases, whistleblowers who expose healthcare industry fraud can receive rewards under the False Claims Act when their claims (formally called “qui tam complaints”) lead to successful enforcement actions.

EHR whistleblower rewards under the False Claims Act are generally calculated as follows:

·     15% to 25% of the Amount Recovered – If the Justice Department decides to intervene following the government’s investigation, an EHR whistleblower is generally entitled to a reward of 15% to 25% of the amount the government recovers.

·     25% to 30% of the Amount Recovered – If the government decides not to intervene, an EHR whistleblower can pursue their case directly. In this scenario, the whistleblower will generally be entitled to a reward of 25% to 30% of the amount recovered.

Within each of these ranges, a whistleblower’s level of involvement in the case is a key factor for determining the specific percentage awarded. When we help whistleblowers expose fraudulent claims involving EHR, we work with the federal government directly on behalf of our clients to help maximize our clients’ reward eligibility.

The Process of Filing a Whistleblower Complaint for EHR Fraud Under the False Claims Act

If you are eligible to serve as an EHR whistleblower, how can you seek a monetary reward under the False Claims Act? Here is an introduction to the key steps in the process:

1. Documenting Electronic Health Records Fraud

The first step is to document the EHR fraud that you are prepared to report to the federal government. However, employees need to be careful about copying their employers’ records, so we strongly recommend consulting with a whistleblower attorney before collecting any additional documentation.

Medical professionals, employees of healthcare service providers, employees of EHR software developers, and other individuals can report forms of EHR fraud including (but not limited to):

Failures Involving EHR Systems Compliance (Including Federal Certification Fraud)

Failures involving EHR system compliance that result in billing fraud or that compromise patient safety or patient care can warrant qui tam complaints under the False Claims Act. This includes failures related to certification testing noncompliance and noncompliance with other federal requirements.

Meaningful Use Fraud Involving EHR Systems

Federal law requires healthcare providers to make “meaningful use” of their EHR systems in order to be eligible for federal incentive payments. Meaningful use fraud is a common issue in EHR whistleblower cases.

Medicare and Medicaid Fraud Involving EHR Incentive Payments

Along with meaningful use fraud, other forms of fraud that allow healthcare providers to improperly receive EHR incentive payments can warrant whistleblower complaints as well. Ultimately, if a healthcare provider (or another entity) improperly obtains taxpayer money through any means, this can potentially justify a qui tam complaint under the False Claims Act.

Misuses of EHR Software (Including Improper Use of EHR Clinical Decision Support)

Misusing EHR software to fraudulently bill for unnecessary tests and unnecessary treatment is another common form of EHR fraud. There are various ways to document a healthcare provider’s misuse of EHR software, and our whistleblower attorneys can assist both you and the DOJ as warranted.

Payment or Receipt of Illegal Referral Fees

The Anti-Kickback Statute prohibits healthcare providers and other entities from using taxpayer-reimbursed funds to pay for referrals. Providers and other entities involved in the payment of illegal kickbacks can face civil or criminal liability under the False Claims Act depending on the specific circumstances involved.

2. Filing a Qui TamLawsuit in Federal Court

After gathering sufficient documentation, the next step is to file a qui tam lawsuit in federal court. Our whistleblower attorneys handle qui tam cases involving companies in the medical industry and the EHR industry. If you are eligible to come forward under the False Claims Act, our attorneys can file your qui tam lawsuit on your behalf.

3. Working with the U.S. Department of Justice (DOJ)

The U.S. Department of Justice (DOJ) investigates cases filed under the False Claims Act, and it is responsible for deciding whether to intervene in an EHR whistleblower’s case. After filing your qui tam lawsuit, our attorneys will work with the DOJ on your behalf as it investigates your allegations and decides how to proceed.

4. Awaiting the DOJ’s Decision on Intervention

After investigating, the DOJ will make its decision regarding intervention. As you await the DOJ’s decision, our attorneys will remain in close contact with the prosecutors handling your case; and, if the DOJ decides not to intervene, we will help you make an informed decision about whether you want us to continue pursuing your case on your behalf.

5. Filing for an Award if Your Case is Successful

If your case leads to a financial recovery for U.S. taxpayers, our attorneys will work with the DOJ to secure your whistleblower award. Our attorneys will file for your award, and then we will work with the DOJ to negotiate a fair award amount based on your contributions to the government’s case. If you receive an award, our attorneys’ fees will be deducted from your award amount.

FAQs: Filing an EHR Whistleblower Lawsuit Under the False Claims Act

Schedule a Free and Confidential Consultation with an Experienced EHR Whistleblower Lawyer

If you would like more information about seeking an electronic health records (EHR) whistleblower award, we invite you to contact us for a free consultation. This consultation is 100% confidential, and you are not obligated to move forward with blowing the whistle. To speak with an experienced EHR whistleblower lawyer in confidence, call 888-680-1745 or request an appointment online today.