A whistleblower accused Franklin, Tenn.-based Community Health Systems of submitting hundreds of millions of dollars in false claims to HHS for federal incentive payments for meaningfully using electronic health records.
The lawsuit, unsealed by a federal court in Miami on Thursday, claimed that CHS made it a priority for its hospitals to submit attestations for incentive payments because they were an important source of revenue for the system. The two whistleblowers, who worked for CHS as recently as December 2016, allege the for-profit system received more than $450 million in EHR incentive payments between 2012 and 2015.
HHS makes Medicare and Medicaid incentive payments to hospitals and physicians that demonstrate meaningful use of certified EHR technology through the Promoting Interoperability Program, which was formerly known as meaningful use. To qualify for incentive payments, hospitals and clinicians have to attest that they used certified technology and satisfied certain program objectives.
"Even though the flaws and lack of reliability with both the Medhost software and CHS' implementation of the software should have made the CHS hospitals ineligible for Meaningful Use incentive payments, CHS and CHS hospitals knowingly misrepresented to the government that the hospitals were eligible for subsidy payments," the complaint states.
In a statement, CHS said it believes the whistleblower allegations are "without merit" and "has complete confidence that all of its meaningful use attestations have been accurate."
The federal government has not yet intervened in the lawsuit, saying it has not completed its investigation by the court's deadline and is not yet able to decide whether to proceed, according to a notice filed with the court on Tuesday. The notice stated that the government would continue its investigation.
The software implemented at CHS hospitals and developed by vendor Medhost, who is also named as a defendant in the complaint, contained flaws that prevented clinicians from providing care safely and reliably, making the software ineligible for certification under the incentive program, the complaint alleges. CHS implemented the EHR software rapidly to be able to reap more incentive payments, which led to additional problems with the software's performance and endangered patients, the lawsuit alleges.
For example, the complaint says problems with the EHR technology led doctors to inadvertently order incorrect medications or dosages. The technology also was unable to trigger medications to be delivered at the right time, perform drug interaction checks or lock patient charts while open, according to the complaint.
"Some of the defects in the software, including an inability to calculate weight-based dosing accurately, exposed patients to mistakes that were easily missed in institutional settings and potentially catastrophic," the complaint said.
CHS said in its statement that it worked diligently to address any issues with the EHR technology and is unaware of any instances of patient harm.
Doctors and hospital administrators sounded the alarm about the flaws, but CHS continued to roll out the software across its hospitals. CHS and Medhost then knowingly and falsely attested that the software complied with certification requirements, the complaint alleges.
The complaint further alleges that the 60 hospitals CHS acquired from Health Management Associates similarly did not meet certification requirements, yet CHS knowingly attested the software did.