The U.S. Department of Justice is joining a whistleblower lawsuit against electronic health records vendor Modernizing Medicine.
The lawsuit, originally filed in 2017, alleges violations of the False Claims Act, including misuse of federal EHR incentive programs that resulted in illegal kickbacks for physicians.
Boca Raton, Florida-based ModMed, which creates cloud-based EHR software, allegedly did not comply with the requirements for certification under the EHR incentives programs and lied to certifying bodies about that compliance, leading to inaccurate upcoding and in some cases putting patient health at risk, according to the complaint.
A former ModMed executive filed the whistleblower complaint, which a federal district court in Vermont unsealed last week nearly five years later.
That executive has been revealed to be Amanda Long, who joined ModMed as a product director in 2014 and resigned in 2017 as vice president of product management.
“I am pleased the Justice Department recognizes the seriousness of this matter and is intervening in the case after investigating my allegations,” Long said in a statement.
The filing signaling the DOJ’s intention to intervene in the case names ModMed CEO Daniel Cane and Chief Medical Officer Michael Sherling, M.D., as defendants alongside the company itself.
Regarding the allegations, a ModMed spokesperson wrote in an email to Fierce Healthcare: “At ModMed, we stand behind the integrity of our products and our people. We remain steadfast in our mission to place doctors and patients at the center of care through an intelligent, specialty-specific cloud platform. The company disagrees strongly with the allegations in the qui tam (whistleblower) complaint and we intend to defend vigorously against them.”
The DOJ said it expects to file its complaint with allegations against each of the defendants within 90 days of its decision to intervene, issued on March 15.
Healthcare fraud made up the majority of False Claims Act settlements and judgments last year, according to the DOJ.
The agency said it recovered more than $5.6 billion from civil fraud and false claims cases for the fiscal year ending Sept. 30, 2021, with more than $5 billion resulting from healthcare-related cases.
That’s a big jump from the funds recovered in prior years, with $1.8 billion received from healthcare fraud and false claims cases in 2020 and $2.6 billion in 2019.