In a whistleblower lawsuit, two former senior IT executives at Community Health Systems allege the healthcare system submitted hundreds of millions of dollars in false claims to the U.S. Department of Health and Human Services to receive federal meaningful use incentive payments.
The healthcare system’s Medhost EHR software suffered from “pervasive flaws” making it ineligible for meaningful use certification, according to the plaintiffs, who also accuse Medhost of “knowingly and falsely” attesting that its software complied with MU certification requirements.
The EHR flaws, including multiple design failures in its computerized physician order entry and clinical decision support software, prevented healthcare providers from providing clinical care in multiple CHS hospitals safely and reliably, the former IT executives claim in the lawsuit. “Many of the flaws create an acute risk to patient health and safety,” they allege in the complaint.
Community Health Systems, based in Franklin, Tennessee, operates 127 hospitals in 20 states. In an emailed statement, CHS spokesperson Tomi Galin said CHS has reviewed the lawsuit and “finds the allegations in the lawsuit to be without merit and has complete confidence that all of its Meaningful Use attestations have been accurate.”
In a statement posted on its website, Medhost said it "categorically denies" all the allegations in the complaint. "Hundreds of facilities have successfully used our software over the years and continue to do so today. Also, we continue to have new buyers of our products and services, many of whom are large sophisticated organizations that conduct exhaustive analyses and comparisons of Medhost to others in the industry," the company said.
Medhost also said it is cooperating with the Department of Justice in its civil investigation, including DOJ requests for certain information and documentation regarding certification of its EHR products and related meaningful use activities.
The lawsuit was filed in January 2018 in the United States District Court in Miami and was recently unsealed. In a notice filed with the court on Tuesday, the Department of Justice said it was not intervening in the lawsuit at this time but also noted that it has not completed its investigation into the False Claims Act allegations. The notice stated that the government would continue its investigation.
The plaintiffs in the lawsuit are Derek Lewis, who worked in various IT roles at the health system from 2009 to 2016, including director of technology adoption, deployment, and Joey Neiman, the health system's manager of health information system delivery, deployment services from February 2014 to December 2016.
According to the lawsuit, Lewis was responsible for managing EHR implementation projects at CHS hospitals and Neiman oversaw the building of EHR systems as part of hospital conversions and acquisitions, as well as program management for various projects involving CHS’s EHR software.
Lewis and Neiman claim that CHS rolled out the EHR at a rapid pace and took short cuts in order to submit attestations for meaningful use stage 2 incentive payments, which resulted in additional defects.
“Among other things, CHS mapped many order sets incorrectly to hospital formularies, causing doctors to inadvertently place orders for incorrect medications and medication dosages,” the lawsuit states. One CHS employee warned the flaws had “a very high potential for causing a catastrophic event,” according to the lawsuit.
The law firm representing Lewis and Neiman, Washington, D.C.-based firm Phillips & Cohen, also represented whistleblower Brendan Delaney in a lawsuit against EHR vendor eClinicalWorks filed back in 2015. The DOJ intervened in that case which resulted in the vendor paying $155 million to settle False Claims Act allegations.
The federal government used the Meaningful Use program, now known as Promoting Interoperability, to distribute more than $38 billion to eligible providers to install EHR systems, including $21.7 billion to hospitals.
The lawsuit against CHS names all 127 CHS hospitals as each hospital “attested to meaningful use of certified EHR technology based on their use of Medhost or Pulse software,” and also names CHSPSC, a subsidiary of CHSI that manages CHS's hospitals and other affiliates.
Lewis and Neiman allege that the meaningful use EHR incentive payments were an important revenue stream for the health system, which received $544 million in incentive payments.
“With large amounts of money at stake, CHS made it a business priority for as many of its hospitals as possible to submit allegations for meaningful use incentive payments,” the lawsuit states. Through the use of special implementation terms, CHS aimed to maximize the number of its hospitals receiving the incentive payments, the former executives allege.
Despite knowing about the software design flaws, the EHR vendor, Medhost, attested that its software complied with requirements for stage 2 certification for the payment of incentives under the meaningful use program, the lawsuit alleges.
As a result of the use of Medhost software, CHS and its hospitals presented false attestations to the government about hospital compliance with required meaningful use objectives and measures to obtain federal subsidies.
Lewis and Neiman claim that CHS officials knew the EHR software was “defective and unreliable” and does not meet federal EHR certifications. The health system’s implementation of Medhost’s software compounded problems with the software, they claim, making the EHR system “even more unreliable and often dangerous.”
According to CHS’s statement, "during implementation of the Medhost EHR system, the company worked diligently to address any issues, appropriately and promptly, and consulted with third-party experts to help validate the work."
“Despite insinuations to the contrary in the litigation, we are unaware of any instances of patient harm. As an organization, we are devoted to patient safety and have always prioritized the quality of care provided in our hospitals as our most important responsibility,” CHS said.
According to the lawsuit, CHS also misrepresented its eligibility for incentive payments for 60 hospitals that the health system acquired through a merger with Health Management Associates. The Pulse modular EHR software at those hospitals was not integrated properly, forcing clinicians to resort to paper, Lewis and Neiman allege.
The lawsuit states that the plaintiffs seek to recover damages and civil penalties for the False Claims Act violations.