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Analysis

Practice Fusion to Pay $145M to Settle Criminal, Civil Kickbacks Allegations

By John Commins  
   January 28, 2020

The San Francisco-based EHR vendor admitted that it took $1 million in kickbacks from opioid makers in a scheme to increase prescriptions.

Electronic health records vendor Practice Fusion Inc. will pay $145 million for its role in a five-year criminal scheme that colluded with opioid makers to trick physicians into prescribing their addictive pain medications, the Department of Justice announced.

The case is the first ever criminal action against an EHR vendor.

According to federal prosecutors, the San Francisco-based software vendor accepted "sponsorship" payments of $1 million from pharmaceutical companies between 2014 and 2019 that allowed the drug makers to design and develop and implement clinical decision support alerts that recommended the companies' products.

Prosecutors said Practice Fusion bragged to drug makers about the expected profits that would come from gaming CDS alerts.

The opioid makers selected the guidelines used to develop the alerts, set the criteria that would determine when a healthcare provider received an alert, and even drafted the language used in the alert itself, DOJ said.

"Practice Fusion's conduct is abhorrent," said Christina E. Nolan, U.S. Attorney for the District of Vermont, who led the investigation.

"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," Nolan 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," she said.

Attempts to contact Practice Fusion for comment were unsuccessful.

Under a deferred prosecution agreement with DOJ, Practice Fusion will admit that it asked for and received the kickbacks in exchange for rigging the software and will pay more than $26 million in criminal fines and forfeiture.

In separate civil settlements, Practice Fusion will pay $118.6 million to the federal government and states to resolve the kickback allegations that caused the software's users to submit false claims for federal incentive payments by misrepresenting the capabilities of their EHR software

The Deferred Prosecution Agreement requires Practice Fusion to ensure acceptance of responsibility and transparency as to its underlying conduct, and to invest in compliance overhauls and independent oversight.

The agreement also requires Practice Fusion to make documents relating to its criminal conduct available to the public through a website.

“Practice Fusion's conduct is abhorrent.”

John Commins is a content specialist and online news editor for HealthLeaders, a Simplify Compliance brand.

Photo credit: Mark Van Scyoc / Shutterstock.com


KEY TAKEAWAYS

Practice Fusion accepted "sponsorship" payments of $1 million from drug makers.

In exchange, the drug makers designed and implemented clinical decision support alerts in the software that recommended the companies' addictive products.

Practice Fusion bragged to drug makers about the expected profits that would come from gaming CDS alerts.

The case is the first ever criminal action against an EHR vendor.


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