Electronic medical record (EMR) fraud costs taxpayers millions of dollars and compromises the level of care that all patients receive. While EMR software was meant to revolutionize the medical field by streamlining patient record storage, creating a centralized resource, and helping increase diagnosis accuracy, instead EMR software systems have been embroiled in instances of fraud, waste, and abuse nationwide.

If you report electronic medical records fraud, you may be able to receive a significant financial reward in exchange for your information. EMR fraud and abuse should not be tolerated in any medical institution, especially those that are funded by taxpayer dollars. To report medical record fraud, speak to a qualified qui tam lawyer to understand your options as well as how to put in a claim for your reward.

What is EMR Software Fraud?

The best electronic medical record software was intended to create a digitized storage system for patient medical records. This would allow health records to be accessed more easily, and vital information such as diagnostics, test results, vaccination records, allergy information, prescription drugs, and more would all be easily available to doctors and patients. Instead, EMR fraud has allowed faulty systems to flourish, causing medical professionals to spend too much time clicking screens instead of providing patients care.

Meanwhile, proprietary design creates barriers to sharing information between systems, and pharmaceutical advertisers can take advantage of the infrastructure to push their products onto patients and prescribers. All of these flaws are subsidized by taxpayer dollars, thanks to EMR stimulus programs that reimburse the cost of investment in EMR technology.

Electronic medical record software fraud takes place any time medical providers certify that their EMR system meets minimum compliance standards when it actually does not. Additionally, EMR software companies that wrongfully claim compliance with these standards may also be held accountable via a qui tam claim.

Types of EMR Fraud

Common examples healthcare fraud involving electronic medical records include:

• Kickbacks: Providing kickbacks, or incentives in the form of direct payments, discounts, or dangling additional goods or services is illegal in the medical field. EMR incentive program fraud often involves offering kickbacks or incentive payments in order to convince hospitals to invest in a company's particular software. It may also involve vendors offering or accepting marketing kickbacks to or from pharmaceutical companies in order to sell their products to users of the EHR software.

• Meaningful use fraud: EMR software must meet certain minimal "meaningful use" standards and be certified as such in order to qualify for government reimbursement. Meaningful use fraud involves vendors as well as hospitals mis-certifying non-qualifying EMR technology in order to receive stimulus payments. Reimbursement for this technology is funded by taxpayers, so false claims regarding EMR certification costs you directly.

• Medical billing fraud: Medical billing fraud can take place without the use of EMR technologies. However, the complexities and discrepancies of many EMR systems have allowed for increased instances of medical billing fraud. Improper billing, unbundling, ordering medically unnecessary tests, and more can all be obscured by EMR systems in order to claim wrongful Medicaid or Medicare funds.

• Misrepresentation of system capabilities: Vendors must accurately represent EMR system capabilities, otherwise they can be held accountable for fraud. There have been instances of EMR software developers coding models to work specifically for certification testing, and then selling non-working models or software riddled with errors to hospitals in order to cut corners on their overall cost. Doing so is illegal and reportable for a possible EMR whistleblower reward.

How Does EMR Fraud Harm Patients and Taxpayers?

Electronic medical record fraud has been linked to millions of dollars of waste and loss for American taxpayers. Meanwhile, the faulty medical technology has even been tied to the death of some patients, as well as unconscionable delays in necessary treatment.

EMR Fraud Effects on Patients:

• Errors in medical records: Medical records may be incomplete, difficult to access, or even confused with information from another patient.

• Fraudulent "clinical decision support feature": The "clinical decision support feature" has been linked to EMR fraud kickback cases involving pharmaceutical manufacturers. This design in the software has the capability to suggest medical options that are not necessarily in the patient's best interests, creating a dangerous situation for those receiving medical care.

• Suggestions for more expensive prescriptions: Kickback cases have also involved advertising for non-generic or more expensive prescription options coded within the electronic health records software.

• Failure to recognize dangerous drug interactions: When vital information is missing from patient health records, dangerous drug interactions or possible allergies may not be highlighted on screen. This may cause prescriptions to be given without a full understanding of the possible risk involved.

• Poor integration with other systems: Many EMR systems have had significant difficulty or even a complete inability to share information between providers, and in many cases, this is built in as part of the proprietary design. This makes switching between medical providers or seeing specialists unnecessarily difficult for patients.

How EMR Fraud Harms Taxpayers:

• Profit over functionality: Developers may place potential for profit over the well-being of patients and the genuine needs of healthcare providers.

• Fraud, waste, and abuse: Furthermore, tax dollars are invested in the promulgation of EMR systems that serve to financially benefit software companies instead of creating the best product possible.

Who Can Be an EMR Fraud Whistleblower?

Anyone with information about faulty EMR systems, false certifications, or any other form of EMR fraud can become a whistleblower. Many EMR fraud whistleblowers work for medical record software companies or in the medical field. However, you do not have to work for the company committing the fraud in order to blow the whistle on illegal activity. You do not even have to be an American citizen to qualify for a whistleblower reward if you have information about electronic health record fraud. Coming forward is always the right thing to do, and the Department of Justice rewards whistleblowers from all backgrounds in order to incentivize reporting.

EMR Fraud Whistleblower Rewards

If you have information to blow the whistle on EMR fraud, you may be eligible to receive a financial reward under the False Claims Act. This powerful anti-fraud law penalizes offenders with up to treble damages per false claim and allows whistleblowers, or qui tam relators, to collect up to 30% of the overall recovery in a successful case. A whistleblower's award percentage is decided based on the value of their information, the extent of their cooperation with the investigation, their role in the overall recovery, and their own culpability or lack thereof in the fraud that took place.

Are EMR Fraud Whistleblowers Protected from Retaliation?

Electronic medical record fraud whistleblowers are protected from retaliation by their employers. If you file an EMR fraud claim with the Department of Justice, any attempted retaliation by your employer is subject to legal action. You may be able to recover up to double back pay or front pay, as well as possible reinstatement, damages, and legal fees if your employer harasses you, discriminates against you, suspends, demotes, or fires you as a result of your protected disclosure.

EMR Fraud: FAQ's

The following represent some frequently asked questions about EMR fraud and becoming a healthcare fraud whistleblower.

1. What evidence do I need to file an EMR whistleblower claim?

The evidence you need to file a successful EMR whistleblower claim varies. For instance, if you are a software developer at an electronic health record software company, you may have a lesser burden of proof than someone who works at a hospital with a faulty EMR system and becomes suspicious of the certification that their in-house system received. It is advisable to consult with an EMR fraud lawyer about the specifics of your case, including which details of medical records are permissible to share by law when reporting fraud.

2. How much of a reward am I entitled to if my whistleblower claim is successful?

If your whistleblower claim is successful, you are entitled to anywhere from 15 to 30% of the overall recovered funds. The percentage you may receive is decided based on several factors, one of these being whether or not the government decided to intervene in your case. If not, you may be eligible to receive the full 30% of the settlement if the case was propelled solely by your own attorneys and evidence.

However, if the government does decide to intervene, they may be able to use powerful tools in order to collect even more evidence of wrongdoing, leading to higher recovery amounts overall. The value of your information in proportion to the final amount plays a role in deciding how much you can receive as your whistleblower payout.

3. How long does an EMR fraud case typically take to resolve?

An EMR fraud case can take months or years to resolve, depending on the scope of the alleged fraud. At times, the discovery of one fraudulently certified software program may open the door to follow-up cases from other medical providers who have invested in the same technology.

4. What is the HITECH act?

Before the passage of 2008's HITECH Act, only 10% of hospitals in American had adopted EMR technology. The cost of investing in EMR programs was prohibitively expensive for everyone except the largest private hospitals, which created discrepancies in the system nationwide. to give more health care providers the opportunity to invest in what was then emerging EMR technology, the HITECH Act created financial incentives and reimbursement programs for hospitals that invested in EMR technology which passed certain meaningful use standards.

5. What is meaningful use fraud?

Meaningful use fraud occurs whenever electronic medical record technology fails to meet designated minimal standards for operation but is still funded by stimulus payments from the government. Meaningful use fraud wastes taxpayer money on ineffective, inoperative technology that can actually harm patients and providers. If you can report meaningful use fraud with EMR technology, do so at once.

Report EMR Fraud and Save Lives

Reporting EMR fraud is the right thing to do. Hospitals and patients deserve medical technology that works, and the American taxpayer deserves to get what their tax dollars pay for. If you believe you have information that qualifies you to become an EMR whistleblower, contact an experienced qui tam law firm to see what kinds of evidence you will need to share in order to bring a claim and earn a possible reward.