21st Century Oncology: False EHR Reports Dressed up With Vendor Logos

The $26 million 21st Century Oncology EHR settlement covered self-disclosed false meaningful-use attestations and separate physician-referral allegations. The company’s account of its electronic health records reporting went beyond false answers to Medicare: employees had manufactured the reports meant to support those answers. If you worked on EHR reporting, compliance or physician compensation, this case shows why the work behind a submission can tell a different story from the document the government sees.

The Department of Justice announced the agreement on December 12, 2017. It named 21st Century Oncology Inc., a business headquartered in Fort Myers, Florida, whose operations provided integrated health care for cancer patients throughout the United States, including radiation oncology, medical oncology and urology. The EHR conduct reached the government through the company’s self-disclosure. A former finance executive brought the separate referral allegations through a whistleblower case.

False EHR Reports With Borrowed Credibility

21st Century Oncology reported that it knowingly submitted, or caused the submission of, false attestations to the Centers for Medicare & Medicaid Services about employed physicians’ use of EHR software. The district announcement describes the company’s self-disclosure in unusually concrete terms: employees falsified EHR-use data, fabricated software-utilization reports and superimposed EHR vendor logos on those reports to make them look legitimate.

That last step matters. The logo gave a fabricated report the appearance of something the software vendor had produced. The company’s account described a false claim about use, false supporting data and a false appearance of authenticity. We see the absurdity in dressing up invented evidence with the brand of the system it supposedly measured. A logo doing the work of proof.

The special agent in charge for the Department of Health and Human Services’ Office of Inspector General said the company admitted violating meaningful-use regulations to fund an electronic health records system and falsifying records to cover it up. We see a program meant to pay for meaningful use paying for an invented account of that use instead.

For an insider who prepared or reviewed meaningful-use attestations, the useful connection is between the submitted answer and the report offered to support it. We examine how that report was produced, what data it represented and who knew how it had been assembled. A person who saw the original output may explain something that the finished, branded document conceals.

The Separate Stark Claims Came From a Whistleblower

The government alleged that 21st Century Oncology paid referring physicians in ways the physician self-referral law, the Stark Law, does not allow, then billed Medicare for the services they referred.

The company’s former interim vice president of financial planning brought those allegations in a qui tam case under the False Claims Act, bringing the claims on the government’s behalf. That matters to someone who works with physician compensation: an EHR settlement headline can also contain a case rooted in financial relationships and the services those relationships generate.

How Much of a Settlement Does a Whistleblower Get?

A whistleblower case under the False Claims Act can pay 15% to 30% of what the government recovers. In this case, the government announced that the former finance executive would receive $2 million as the whistleblower’s share of the recovery associated with the Stark allegations.

The Corporate Integrity Agreement Required Independent Reviews

21st Century Oncology also entered a new five-year Corporate Integrity Agreement with the Department of Health and Human Services’ Office of Inspector General. The agreement required substantial internal compliance reforms, including hiring independent review organizations to conduct annual claims and arrangements reviews.

What Is the EHR Incentive Program?

Under the historical Medicare EHR Incentive Program, physicians who attested to meaningful use of certified EHR technology could receive incentive payments and avoid downward adjustments to certain Medicare claims. That made the account of actual use financially important. The company described false attestations concerning its employed physicians, supported by the fabricated utilization reports.

The HITECH provisions of the American Recovery and Reinvestment Act of 2009 created Medicare and Medicaid EHR incentives. The original Medicare schedule offered an eligible professional starting in 2011 or 2012 up to $44,000 over five years. The payment structure made EHR adoption a financial decision as well as a clinical one. In an organization employing physicians, the reporting process sat where software use met that government payment.

A 2022 Vassar College senior thesis, A Panacea or a Problem? Electronic Health Records and the Complicated Politics of Its Stakeholder Network, argues that financial incentives accelerated adoption while meaningful integration lagged. Its analysis identifies the pressure built into paying people to adopt a technology:

A Panacea or a Problem? Electronic Health Records and the Complicated Politics of Its Stakeholder Network, Vassar College, 2022

At 21st Century Oncology, the company reported that employees fabricated the evidence supporting its physicians’ attestations. The report could look convincing to Medicare while someone inside the business knew how it was made.

Different EHR cases follow different documents. EHR certification fraud concerns representations about a product’s capabilities in testing and certification. EHR billing fraud can involve false documentation used to support a higher service charge. Here, the company’s disclosure concerned its account of physicians’ software use. For the person who knows the system, identifying which representation carried the payment is where we begin.

Coffey Health System and the Origin of the Data

Coffey Health System’s whistleblower complaint describes a similar concern about making manually prepared material appear to come from certified technology. The complaint alleged that the hospital manufactured clinical-quality data and disguised its origin:

United States ex rel. Awad v. Coffey Health System, whistleblower complaint, January 15, 2016, paragraph 84

The allegation concerns clinical-quality measures and certified EHR technology. It gives the person who prepares reports a recognizable question: where did the data actually come from? The common concern is a document made to look as though the system generated it.

Coffey’s settlement announcement identified a narrower allegation: false attestations that the hospital had conducted or reviewed security-risk analyses. Coffey agreed to pay $250,000.

21st Century Oncology’s HIPAA and Earlier Settlements

The company’s HIPAA resolution addressed potential privacy and security violations in a separate agreement with the Department of Health and Human Services’ Office for Civil Rights. The agency’s December 28, 2017 account states that 21st Century Oncology agreed to pay $2.3 million and adopt a comprehensive corrective action plan.

Earlier False Claims Act settlements concerned medically unnecessary fluorescence in situ hybridization testing, commonly called FISH testing, and Gamma-function radiation billing.

The distinction matters to the reader who knows one part of the business. An employee working on utilization reports, a finance employee familiar with physician arrangements and someone responsible for protecting patient information may recognize different conduct. We start with what you saw and the payment or representation it affected.

You Know How the Report Was Made

If you saw utilization reports manufactured for an attestation, or physician payments behind the referrals, speak to one of our Whistleblower Experts about what you saw. We work beside you to build your strongest whistleblower case and bring in healthcare fraud whistleblower lawyers with experience in EHR incentive claims and physician compensation. From the first conversation through the case, you have a team that understands why the report’s origin matters as much as its contents.