PenRad Technologies: A Breast-Cancer Risk Setting and Unnecessary MRI Claims

In the PenRad Technologies False Claims Act settlement, the software company agreed to pay $529,069 to resolve allegations that its breast-cancer risk calculator configuration caused medically unnecessary MRI claims to Medicare and MassHealth. PenRad knew the recommended setting for clinical use, sometimes installed the calculator with that setting disabled, and accepted responsibility for the facts supporting the settlement. For the people who install clinical software or use its results, the case reaches a familiar handoff: what the vendor knows and what the customer actually receives.

PenRad Technologies, Inc. is a software company headquartered in Raleigh, North Carolina. The Justice Department announced the settlement on December 15, 2025.

What PenRad’s Series 7 Software Did

PenRad’s software let health care providers use the Tyrer-Cusick risk calculator to assess a patient’s risk of developing breast cancer and make treatment decisions. The model was publicly available and developed by researchers unaffiliated with PenRad. PenRad supplied the software through which its customers used it.

The calculator offered a choice called competing mortality. With that option enabled, the calculation considers the risk that the patient will die from something other than breast cancer. The calculator’s documentation recommended enabling the option in a clinical setting.

When PenRad released Series 7, it knew what the documentation recommended. It also recommended internally that employees enable competing mortality.

How a Disabled Setting Reached Medicare and MassHealth Claims

When customers upgraded to Series 7 in subsequent years and added the calculator, PenRad sometimes installed it with competing mortality disabled. PenRad also failed to communicate consistently that customers should enable it.

At least one PenRad customer unknowingly used the calculator with competing mortality disabled. Some patients received elevated risk scores, which caused them to receive medically unnecessary MRIs. Providers billed some of those unnecessary scans to Medicare and MassHealth, the Massachusetts Medicaid program.

We find that hard to defend: PenRad knew the recommended setting, while the customer did not even know it was off. The consequences reached both patients receiving unnecessary scans and taxpayers billed for them.

The settlement addressed PenRad’s role in causing those claims even though the providers submitted the bills. For someone examining EHR billing fraud, that is why the clinical decision and the payment request belong in the same account. The person who understands the configuration and the person who sees the claim may hold different parts of it.

Clinical Software Depends on How It Is Installed

The PenRad case puts installation and customer communication at the center of clinical decision support. Broader health IT safety evidence helps explain why those details deserve attention.

In its 2015 alert, Safe Use of Health Information Technology, the Joint Commission analyzed 120 health IT-related serious safety events: human-computer interface issues accounted for 33% of contributing factors, compared with 6% for hardware and software. That pattern puts the way people encounter and use a system at the center of its safety, a useful perspective on PenRad’s installation and communication failures.

An earlier software case approached the difference between the product presented and the product used from another direction. In its 2023 NextGen Healthcare settlement announcement, the Justice Department alleged that an auxiliary product built for certification testing concealed missing functionality in the electronic health records software released to customers. That allegation concerned what passed the test. PenRad’s case concerned how a clinical calculator was configured when customers added it. Both accounts make the deployed product worth examining closely.

A closer parallel appeared in the 2019 Greenway Health case. The Justice Department alleged that an earlier version of Prime Suite miscalculated the percentage of office visits at which providers distributed clinical summaries. Some users consequently attested falsely that they qualified for EHR incentive payments. The government alleged that Greenway knew of the error and left it uncorrected so users would receive those payments. The connection to PenRad is the movement from a software-generated result to a government claim, and the vendor’s knowledge of the problem along the way.

What PenRad Admitted

PenRad admitted, acknowledged and accepted responsibility for the facts supporting the settlement. The Justice Department also credited the company for cooperation under its False Claims Act guidelines.

The Massachusetts U.S. Attorney’s Office and the Massachusetts Attorney General’s Medicaid Fraud Division handled the matter.

What Evidence Is Needed to Report Fraud?

For a case involving a clinical calculator, we connect the recommended setting, the installed configuration, customer communications, clinical output and the claims that followed.

An employee involved in an upgrade may understand how the configuration was chosen. A support employee may know what customers were told. A clinician may understand how the score affected the decision to order an MRI, while a billing employee can explain where the claim went. These are different views of the same sequence.

We work with the insider to connect those views. The important account explains what happened in the product, who understood it, what reached the customer and how it affected the care billed. Your knowledge of that handoff can make a technical setting intelligible as part of a healthcare fraud case.

Can a Whistleblower Report EHR Fraud?

Yes. A whistleblower can report electronic health records fraud, and the PenRad settlement resolved a qui tam whistleblower case brought by an organization. The Justice Department said the organization would receive a portion of the settlement.

A whistleblower case under the False Claims Act can pay 15% to 30% of what the government recovers. If your work gives you a view of the software decisions behind government claims, speak to one of our whistleblower experts about building your strongest case.

You Know How the Calculator Reached the Clinic

If you know how a clinical tool’s settings or customer instructions led to unnecessary care and government claims, speak to one of our whistleblower experts about how the setting reached the bill. We build your strongest healthcare whistleblower case around your knowledge of the product and its use, and bring in healthcare fraud whistleblower lawyers who understand software-driven claims. We stand beside you through the case.