69 Indiana hospitals accused of retaining $324M in fraudulent EHR incentive payments


https://www.beckershospitalreview.com/legal-regulatory-issues/69-indiana-hospitals-accused-of-overbilling-for-medical-records-in-324m-scheme.html

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A recently unsealed lawsuit filed by attorneys under the qui tam, or whistle-blower, provision of the False Claims Act accuses Indiana hospitals of overcharging patients for their electronic medical records.

Here are eight things to know about the lawsuit.

1. After experiencing difficulty obtaining medical records from four Indiana hospitals in their work on personal injury and medical malpractice cases, attorneys from Anderson, Agostino & Keller sued the hospitals in September 2016. They alleged the hospitals falsely certified they were meaningful users of EHR technology.

2. Under meaningful use stage 1, hospitals could show compliance and receive incentive payments by filing attestation documents reporting compliance with core criteria requirements. The lawsuit against the Indiana hospitals focuses on core measure No. 11, which aimed to provide patients with electronic medical records within three business days of receiving a request from the patient or their agent.

3. To receive the incentive payments, hospitals had to show the number of medical record requests they received annually and if the records were supplied to those requesting them within three business days. Hospitals that failed to meet at least 50 percent of their requests within the time frame would not be eligible to receive incentive payments.

4. Based on their experience requesting records from the hospitals and after examining public disclosures, the lawyers alleged the hospital defendants falsely certified compliance with core measure No. 11.

5. The lawyers also claim the hospitals allowed CIOX Health, a company that provided medical records for the hospitals, to illegally profit from the release of the electronic medical records.

“CIOX routinely and repeatedly engaged in a practice, policy, and/or scheme to illegally and fraudulently over-bill patients for the provision of medical records,” the complaint states.

6. The lawyers added organizations operating an additional 65 hospitals to the lawsuit after examining disclosures and identifying a statistical trend that they argue indicates the same type of fraudulent reporting of core measure No. 11.

7. “In sum, these hospitals have been paid $324,386,169.32 in public funding from the citizens of the United States in return for the promise that patients would be provided with fast, cheap, easy access to their electronic health records, and these hospitals have failed to keep that promise,” the complaint states.

“A failure to properly track and report core measure 11 means that the defendant hospitals did not achieve ‘meaningful use’ as defined by the legislation and its ensuing rules. This means that they were not eligible to receive any funding under this program, and have sought and received the grant funding at issue in a fraudulent manner that constitute false claims for public funding.”

8. The Department of Justice declined to intervene in the lawsuit.

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