#relationshipscams | #dating | Practice Fusion pays $145M in 1st criminal action against EHR vendor

Dive Brief:

  • EHR vendor Practice Fusion will pay $145 million in criminal and civil penalties for soliciting and receiving kickbacks from a drugmaker in exchange for using its software to influence physicians to prescribe opioids, the Department of Justice announced Monday.
  • It’s the first ever criminal action against an EHR vendor, DOJ said. The agency charged the San Francisco-based company, now a subsidiary of Allscripts, with two felony counts of violating the Anti-Kickback Statute. The civil settlement arises from the submission of false claims to federal healthcare programs.
  • Practice Fusion also agreed to a Deferred Prosecution Agreement that requires it to cooperate with any ongoing investigations of the kickback arrangement, make documents related to its unlawful conduct public online and retain an independent oversight organization to review and approve any sponsored clinical decision support.

Dive Insight:

Practice Fusion used clinical decision support alerts designed to increase prescriptions for certain drug products in exchange for sponsorship payments from an unnamed pharmaceutical company’s marketing department, according to DOJ.

Christina Nolan, U.S. Attorney for the District of Vermont, called the conduct “abhorrent” in a news release.

“During the height of the opioid crisis, the company took a million-dollar kickback to allow an opioid company to inject itself in the sacred doctor-patient relationship so that it could peddle even more of its highly addictive and dangerous opioids,” she said. “The companies illegally conspired to allow the drug company to have its thumb on the scale at precisely the moment a doctor was making incredibly intimate, personal, and important decisions about a patient’s medical care, including the need for pain medication and prescription amounts.”

Opioid overdoses are responsible for more than 100 deaths a day on average in the U.S. and 8% to 12% of people prescribed opioids develop a use disorder, according to the National Institute on Drug Abuse.

Allscripts, which acquired Practice Fusion a year ago for $100 million, reported $154 million in transaction and legal costs in the second quarter of last year, mostly related to DOJ investigation of the actions that took place prior to its ownership. It markets Practice Fusion, which was founded in 2005, as geared toward independent practices. The company says on its website it supports 30,000 practices caring for 5 million patients a month.

Practice Fusion was also accused of falsely obtaining certification from the Office of the National Coordinator for Health IT by concealing information that it did not meet data portability and standardized vocabulary requirements.

The fine includes nearly $119 million civil penalties — most to the federal government and a little more than $5 million to states.

DOJ has fined other EHR vendors for kickback allegations, included a $155 million charge to eClinicalWorks in June 2017. And providers have been on the hook for kickbacks as well, including Sutter Health, Sanford Health and a Kentucky hospital, all within recent months. The agency recovered $2.6 billion in healthcare fraud and false claims in fiscal year 2019, making up nearly 90% of the country’s fraud cases in that time period.

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