DOJ Files False Claims Act Lawsuit Against Florida Based Medical Services Company

According to a report from Fierce Healthcare, the Department of Justice (DOJ) has filed a False Claims Act whistleblower lawsuit against Modernizing Medicine, Inc. (ModMed) a healthcare software company with a main headquarters in Boca Raton, Florida. Based on allegations originally filed by a former ModMed representative from Vermont, the DOJ alleges that ModMed misused federal EHR incentive programs. In this blog post, our Florida healthcare billing whistleblower fraud attorneys provide an overview of the allegations raised by the DOJ.

Allegations: Healthcare Billing Fraud Through Misuse of EHR Incentives

 A little more than a decade ago, the Centers for Medicare and Medicaid Services (CMS) established new EHR incentive programs—officially referred to as the Medicare Promoting Interoperability Program. Under this program, hospitals and medical providers that meet certain benchmarks are eligible for a financial reward in the form of an incentive payment.

In a False Claims Act lawsuit filed in a federal court in Burlington, Vermont, a former executive at ModMed alleges that the company misused the EHR incentive program, obtaining additional payments for itself and facilitating illegal kickbacks for physicians. There are strict requirements for EHR incentive payments. The whistleblower alleges that ModMed “miscoded” certain services, thereby obtaining incentive payments that were not truly appropriate.

DOJ Joined the Whistleblower Lawsuit—Intervening to Support Whistleblower 

As with many federal healthcare billing fraud cases, the matter at issue in this case was initially brought to light by an individual employee. A former executive at ModMed filed a False Claims Act lawsuit as a whistleblower. The federal False Claims Act allows individuals to file a type of lawsuit called a qui tam claim. Through a qui tam lawsuit, an individual whistleblower can step into the shoes of the government and take action to challenge financial fraud.

There is strong incentive for whistleblowers to bring qui tam claims: If the claim is successful, the whistleblower is entitled to a share of the money recovered by the federal government. When the government intervenes in a qui tam claim, the whistleblower is entitled to an award worth 15 to 25 percent of the government’s ultimate recovery—varying based on the circumstances of the case.

As happens in some False Claims Act cases, the Department of Justice has decided to join the whistleblower’s lawsuit in the case filed by the former healthcare executive in Vermont. It is now also using its resources to hold ModMed accountable for alleged healthcare billing fraud. The case is still pending. There has been no finding of wrongdoing or liability at this point.

Consult With Our Florida Healthcare Fraud Whistleblower Lawyers Today

At Guttman, Freidin & Celler, our Florida whistleblower rights attorneys have the skills and experience to handle all types of False Claims Act cases. If you have any questions about reporting healthcare billing fraud as an employee, we are here to help guide you through the legal process. Call us now or contact us online to set up a no cost, fully confidential appointment with a lawyer.

Resource:

fiercehealthcare.com/regulatory/doj-joins-false-claims-act-whistleblower-suit-against-ehr-vendor-modmed