Greenway Health Hit with $57M Fine to Settle False Claims Act Allegations

Feb. 6, 2019
“EHR companies are on notice,” says Vermont’s U.S. Attorney

Greenway Health, the Tampa, Fla.-based electronic health record (EHR) vendor, will pay the U.S. Department of Health and Human Services (HHS) $57.25 million to resolve allegations attesting that the company falsely obtained certification criteria, while also causing its users to misrepresent the capabilities of its product, and providing them unlawful payments to recommend it.

The complaint was filed under the False Claims Act and was announced by the Justice Department today. In its complaint, the government contends that Greenway falsely obtained 2014 Edition certification for its EHR product, Prime Suite, when it concealed from its certifying entity that Prime Suite did not fully comply with the requirements for certification.

Under HHS’ meaningful use program, healthcare providers that adopted certified EHR technology and met certain requirements relating to their use of the technology would receive incentive payments from the government. To obtain this certification, EHR vendors are required to demonstrate that their products satisfy all applicable HHS-adopted certification criteria.

According to the DOJ, “Among other things, Greenway’s product did not incorporate the standardized clinical terminology necessary to ensure the reciprocal flow of information concerning patients and the accuracy of electronic prescriptions.  Greenway accomplished its deception by modifying its test-run software to deceive the company hired to certify Prime Suite into believing that it could use the requisite clinical vocabulary.”

What’s more, in order to be eligible to receive incentive payments, healthcare providers were required to meet certain targets for EHR-related activities such as providing patients with clinical summaries following office visits. In its complaint, the government further alleged that Greenway was aware that an earlier version of Prime Suite, which was certified to 2011 Edition criteria, did not correctly calculate the percentage of office visits for which its users distributed clinical summaries and thereby caused certain Prime Suite users to falsely attest that they were eligible for EHR incentive payments. 

“Greenway refrained from rectifying this error in order to ensure that its users would receive incentive payments.  As a result, numerous users of this earlier version of Prime Suite falsely attested that they were eligible for EHR incentive payments when, in fact, they had not met all necessary use requirements,” the complaint stated.

Further, the government alleged that Greenway violated the Anti-Kickback Statute by paying money and incentives to its client providers to recommend Prime Suite to prospective new customers.

United States Attorney Christina E. Nolan for the District of Vermont said the settlement is the second largest civil settlement in the district of Vermont’s history, behind another one involving an EHR vendor—eClinicalWorks, which settled for $155 million in 2017, following allegations that the company violated federal law by misrepresenting the capabilities of its software and for allegedly paying kickbacks to certain customers in exchange for promoting its product.

“In the last two years my office has resolved two matters against leading EHR developers where we alleged significant fraudulent conduct. These are the two largest recoveries in the history of this District and represent the return of over $212 million dollars of fraudulently-obtained taxpayer monies. These cases are important, not only to prevent theft of taxpayer dollars, but to ensure that the promise of health technology is realized in the form of improved patient safety and efficient healthcare information flow,” Nolan said in a statement. She added, “EHR companies should consider themselves on notice.”

U.S. Attorney Byung J. “BJay” Pak for the Northern District of Georgia, added, “Medical professionals and patients depend on the security and competency of electronic health records as a means to improving both the quality and coordination of healthcare services. Vendors who falsify the viability of their products erode the integrity of public health systems and will be held accountable for their misrepresentations.”

According to one local media report in Vermont, Nolan said that one key reason the U.S. attorney’s office in Vermont handled the case was because of expertise it has developed among its staff to investigate such cases. The report also noted that the $57.25 million fine is about double the amount in in alleged false claims the company caused to be paid out by the federal government.

In a statement sent to Healthcare Innovation over email, Richard Atkin, CEO of Greenway Health, said, “Greenway Health today announced a settlement with the U.S. Department of Justice regarding the government’s allegations that our Prime Suite product failed to comply with certain certification and legal requirements resulting in overpayments or improper payments to healthcare providers. The settlement is not an admission of wrongdoing by Greenway, and all our products remain ONC-certified. This agreement allows us to focus on innovation while collaborating with our customers to improve the delivery of healthcare and the health of our communities.”

As part of the settlement, Greenway has entered into a five-year Corporate Integrity Agreement (CIA) with the HHS Office of Inspector General (OIG), covering the company’s EHR software. This agreement requires, among other things, that Greenway retain an independent review organization to assess its software quality control and compliance systems and to review Greenway’s arrangements with healthcare providers to ensure compliance with the Anti-Kickback Statute.

What’s more, Greenway must provide prompt notice to its customers of any patient safety related issues and maintain on its customer portal a comprehensive list of such issues and any steps users should take to mitigate potential patient safety risks. The CIA also requires Greenway to allow Prime Suite customers to obtain the latest versions of Prime Suite at no additional charge, the opportunity to migrate their data from Prime Suite to another Greenway-developed software product also at no additional charge, and to give Prime Suite customers the option to have Greenway transfer their data to another EHR software vendor without penalties, service charges, or any other fees other than contractual amounts still owed in connection with goods or services already provided, according to the DOJ.

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