Practice Fusion, Inc. (Practice Fusion), a San Francisco-based health information technology developer, is to make a payment of $145 million in response to a criminal resolution and civil investigations relating to its electronic health records (E.H.R.) software saga.
Practice Fusion allegedly received illegal kickbacks from pharmaceutical companies in exchange for implementing clinical decision support (C.D.S.) alerts in its E.H.R. software designed to increase prescriptions for their drug products. Healthcare providers throughout 2014 and 2017 were actively involved in using these alerts to write numerous prescriptions. In exchange for what was labeled “sponsorship” payments, the pharmaceutical companies involved were allowed to have a say in developing and executing the C.D.S. alerts. These C.D.S. alerts, however, did not correspond to medical standards.
Practise Fusion persuaded a major opioid company to sponsor the creation of the C.D.S. alerts with promises that it would yield favorable returns. The company invested nearly $1 million in response. This return on their investments was going to come from the numerous prescriptions healthcare providers would be writing due to these C.D.S. alerts. A deferred prosecution agreement was executed by Practice Fusion to the U.S. Attorney’s office for the District of Vermont when kickbacks set in against Practise Fusion.
Practice Fusion was charged with two felony accounts for conspiring with the opioid company to violate the A.K.S., 18 U.S.C. § 371 statutes, as well as anti-kickback statute (A.K.S.), 42 U.S.C. § 1320a-7b (b) (1). This case comes across as the first recorded criminal action against an E.H.R. vendor.
On top of the kickback allegations, the civil settlement with the United States also resolves allegations relating to two intersecting Department of Health and Human Services (H.H.S.) programs. One of these is at the Office of the National Coordinator for Health Information Technology (O.N.C.) that regulates the voluntary health I.T. certification program, and one at the Centers for Medicare & Medicaid Services that oversees E.H.R. incentive programs. Practise Fusion presented false data to escape authentic certification of its E.H.R. software by the O.N.C. After they succeeded in obtaining certification of the 2014 Edition Criteria for the software, they disabled a critical feature of the software.
It was further alleged that Practise Fusion consciously caused eligible healthcare providers to give false attestations of compliance with H.H.S. requirements to receive payments from Medicare and Medicaid between the collective periods from 2014 through 2017.
Practice Fusion entered a civil settlement agreement with the United States to make a payment of $118.6 million. Out of this, $113.4 million would go to the federal government and up to $5.2 million to other states that opt to participate in separate state agreements.
The deferred prosecution agreement imposed stringent measures to keep Practice fusion from repeating such abuses and taking responsibility for its conduct. Some of these include: paying a criminal fine of $25,398,300, forfeiting criminal proceeds of nearly $1 million; cooperate in ongoing investigations; make documents relating to its unlawful conduct available, and reviewing its C.D.S. activities through an independent oversight organization.
For more information on federal criminal charges related to illegal kickbacks, contact our federal criminal defense attorneys in Burlington, Vermont, today.
