Whistleblower Alleges CHS Made Hundreds of Millions in False Claims

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Two whistleblowers have accused Community Health Systems (CHS) of submitting hundreds of millions of dollars in false claims to the Department of Health and Human Services. According to the individuals, the company did this to receive payments from the federal government which were intended to be for “meaningful use of electronic health records.”

According to the lawsuit, CHS made it a priority for its hospitals to submit claims for incentive payments because they were an important source of revenue for the system, despite not meeting the requirements of the program.

Whistleblowers Claim CHS Knowingly Applied for Incentives for Which It Was Not Eligible

The Department of Health and Human Services pays hospitals and doctors Medicare and Medicaid incentive payments when they demonstrate the use of certain technologies. This is done through the Promoting Interoperability Program. In order to qualify for payments, medical facilities must use certified technology and satisfy certain program objectives.

The whistleblowers making the accusations were former employees of CHS and worked for the company until December 2016. They claim CHS received more than $450 million in payments from the federal government between 2012 and 2015.

According to the complaint, under the program, CHS should not have been eligible for incentive payments, but the company “knowingly misrepresented” its eligibility.

CHS stated it believed the claims of the whistleblowers were “without merit” and states that it still believes its claims to be accurate.

The federal government continues to investigate the matter and has not yet intervened in the lawsuit.

CHS Misrepresenting Its Software Puts Patients at Risk

The software in use by CHS hospitals was developed by third-party vendor Medhost. That company was also named in the lawsuit.

According to the complaint, the software in question contained flaws that prevented doctors from providing safe and reliable care, which would make CHS ineligible for compensation under the program. The complaint further stated that CHS implemented the software faster than it should have in order to take advantage of the incentive program and because of the rush, there were additional problems that arose.

The whistleblowers further claim patients in danger because the software allowed doctors to inadvertently order incorrect medications or dosages. This occurred because the software did not trigger medications to be delivered at the right time, nor did it check drug interactions or lock patient charts. Patients were exposed to risk, in part, because the software did not provide accurate dosing based on patient weight, which meant patients were exposed to “potentially catastrophic” risk.

Despite doctors and hospital administrators speaking out about the potential risks associated with the software’s flaws, CHS continued to use the program and file for incentives from the federal government.

According to CHS, the problems that had been raised by staff and administrators were addressed. The company also claims there were no patients harmed due to any of the software’s problems.

In addition to CHS facilities, the complaint alleges that 60 Health Management Associates facilities acquired by CHS also did not have adequate software programs in place, but CHS claims they did.