EHR provider Modernizing Medicine pays $45M to settle DOJ, whistleblower case alleging False Claims Act Violations, Kickbacks - Yahoo Finance

2 years ago 46

, /PRNewswire/ -- Modernizing Medicine (ModMed), a supplier of cloud-based physics wellness records (EHR) systems, has agreed to wage $45 million to the national authorities to settee a whistleblower suit filed successful 2017 by Phillips and Cohen LLP of Washington, DC and Downs Rachlin Martin of Burlington, Vermont.

ModMed, based successful Boca Raton, Florida, sells cloud-based physics wellness records systems done subscription services, to specialty aesculapian practices including dermatology and orthopedics. Medical providers usage the bundle for objective documentation, prescribing medications, telemedicine, billing, and more.

In March 2022, the U.S. Department of Justice joined the lawsuit against ModMed and its 2 founders and executives, Dan Cane and Dr. Michael Sherling, aft an investigation. Today the United States filed its ailment successful involution alleging, among different things, that, from January 2010 done July 2017, ModMed engaged successful aggregate kickback schemes, including creating a "strategic partnership" with a objective laboratory, Miraca Life Science, wherever Miraca would straight compensate ModMed erstwhile its users sent laboratory orders to Miraca. The alleged amerciable behaviour included providing Miraca with exclusive "enhanced" laboratory interfaces wrong ModMed's EHR that would thrust diagnostic investigating concern to Miraca. The colony resolves the allegations against ModMed. Allegations against Mr. Cane and Dr. Sherling besides are dismissed with solution of this lawsuit.

As portion of the Health Information Technology for Economic and Clinical Health Act (HITECH Act), the national authorities has paid billions of dollars arsenic incentives to healthcare providers to bargain and instrumentality certified physics wellness grounds systems. In 2017, the United States settled the archetypal groundbreaking qui tam suit against an physics wellness grounds vendor, eClinicalWorks, and definite apical executives, for $155 million and established a first-of-its-kind firm integrity statement tailored to wellness IT vendors.

Resolution of the suit with ModMed demonstrates the continued committedness of the United States to enforcing compliance with national requirements for certification of wellness accusation technology. It is besides important due to the fact that it resolves allegations concerning amerciable referral arrangements betwixt the EHR vendor and a objective laboratory, Miraca. The United States alleges that these fiscal arrangements improperly generated income for ModMed and Miraca, portion causing healthcare providers to taxable mendacious claims for reimbursement to the national authorities for pathology services, and mendacious claims for inducement payments for the adoption and "meaningful use" of ModMed's EHR technology. This is believed to beryllium the archetypal clip the United States has taken enforcement enactment nether the False Claims Act against an EHR vendor for providing preferential attraction for a objective laboratory.

"Resolution of this suit is important for a fig of reasons, including that it reminds EHR vendors of the request to comply with the national laws prohibiting kickbacks erstwhile entering into arrangements with 3rd enactment providers including laboratory and different diagnostic services providers wrong the EHR ecosystem," said Colette Matzzie, a whistleblower lawyer and spouse with Phillips & Cohen LLP. "Steering clinicians to nonstop orders to a preferred laboratory has the imaginable to inappropriately power objective decisions. Transparency of these fiscal relationships is indispensable for prime of attraction and beneficiary choice."

The "relator," oregon whistleblower, successful the False Claims Act lawsuit is Amanda (Mandy) Long. Ms. Long was Vice President of Product Management astatine ModMed. She resigned from ModMed successful 2017. Ms. Long is presently CEO and subordinate of the Board of Directors of BigBear.ai. Ms. Long was antecedently Vice President of IT Automation astatine IBM. Ms. Long has implicit 15 years of acquisition successful bundle and hardware portfolios crossed aggregate industries and is simply a taxable substance adept successful merchandise absorption processes and artificial intelligence/machine learning.

"I felt compelled to travel guardant to study my concerns astir decisions made by ModMed that appeared to spot firm profits implicit compliance with national healthcare laws including those intended to support diligent information and prime objective care. I americium grateful that the Department of Justice investigated the substance diligently and recovered these funds for taxpayers," said Ms. Long.

Phillips and Cohen has been a person representing whistleblowers exposing fraud successful the physics aesculapian records industry, with palmy settlements successful the eClinicalWorks litigation ($155 million), Konica Minolta ($500,000), CareCloud ($3.8 million), and, now, Modernizing Medicine ($45 million) litigation. These settlements, and 3 different matters settled by the government, correspond a increasing inclination of DOJ and HHS–Office of Inspector General investigating allegations of fraud successful the improvement and implementation of physics wellness records. Read much astir the lessons learned since the eClinicalWorks colony here.

Lead counsel for Relator were Colette Matzzie of Phillips & Cohen and Tristram Coffin of Downs Rachlin Martin successful Burlington, Vermont. Ms. Matzzie and Mr. Coffin besides represented Relator Brendan Delaney successful the eClinicalWorks case. Tristram J. Coffin was antecedently the US Attorney for the District of Vermont under President Obama.

The whistleblower ailment is posted here.

The United States' Complaint successful Intervention is posted here.

The Settlement Agreement is posted here.

DOJ's property merchandise is here.