#29: First-ever Criminal Action Against an EHR Company

Some of you may want to sit down before reading this one. In a Department of Justice release on January 27, 2020, the first-ever criminal action against an EHR company was announced.  Practice Fusion, a San Francisco-based health information technology developer, used by many providers, will pay $113.4 million to the federal government, $5.2 million to states and $26 million in criminal fines and forfeiture.  

Practice Fusion has admitted to soliciting and receiving kickbacks from a major opioid company in exchange for utilizing its EHR software to influence physician prescribing of opioid pain medications.  In addition, in exchange for “sponsorship” payments from pharmaceutical companies, Practice Fusion allowed these companies to influence the development and implementation of the CDS (Clinical Decision Support) within its software system in ways aimed at increasing sales of the pharmaceutical company’s products. 

The CDS alerts that Practice Fusion agreed to implement did not always reflect accepted medical standards.  They allowed pharmaceutical companies to participate in designing CDS alerts, including selecting the guidelines used to develop the alerts, setting the criteria that would determine when a healthcare provider received an alert, and in some cases even drafting language used in the alert itself.  This is akin to a fox building a “safe” place for chickens to live!!   As Christina Nolan, the U. S. Attorney for the District of Vermont stated, “Practice Fusion’s conduct is abhorrent.” 

Practice Fusion also knowingly caused eligible healthcare providers who used certain versions of its 2014 Edition EHR software, to falsely attest to compliance with HHS requirements necessary to receive incentive payments from Medicare during the reporting periods for 2014 through 2016 and from Medicaid during the reporting periods for 2014 through 2017. 

Okay, go take a shower to get some of that slime off you.  On another front, on January 21, 2020, CMS announced a national coverage determination that would cover acupuncture for people with chronic low back pain, in an attempt to give patients alternatives to potentially addictive narcotic painkillers.  There are, of course, some guidelines such as the pain must have persisted for at least 12 weeks or longer and have no identifiable cause, such as infections, disease, surgery and pregnancy.  Regardless of your opinion of alternative therapies, CMS is making the effort to take another approach to chronic pain. 

I am sure all of you have by now heard of the deadly virus, Influenza.  Thought I was going to say Coronvirus didn’t you?  So far this winter the flu has sickened 15 million Americans, hospitalized 120,000 and killed 8,200.  People freak when they hear Coronavirus and yawn at the word Flu.  Yes, familiarity breeds indifference. 

I hope y’all had a great first month of the new decade and as always I would like to thank you for your business.

Lance Benedict

President/CEO Industry Lab Diagnostic Partners  2/07/2020