Greenway Health has agreed to pay a $57.25 million settlement to resolve healthcare fraud claims alleged against the company in a filed complaint submitted by the United States government.

Greenway, based in Tampa, Fla., is a vendor and developer of electronic health records software. According to Greenway’s website, the company’s software is used by over 10,000 organizations across more than 40 specialties.

Greenway Healthcare Fraud Allegations

The allegations against Greenway claim that the company lied to both customers and the federal government about the capabilities of their “Prime Suite” software, caused its users to submit false claims resulting in healthcare fraud, and unlawfully provided compensation to their users in exchange for recommending the software to new customers.

According to a press release published by the Department of Justice in early February 2019, several allegations have been made against the healthcare software developer. The complaint states that Greenway falsely obtained certification for its Prime Suite software by concealing information about the software, modifying the testing software, and generally deceiving the entity hired to test and certify Prime Suite.

The complaint additionally alleges that Greenway had knowledge of problems with its software, including an error that incorrectly caused some users to believe they were eligible for incentive payments.

The government claims that despite having knowledge of this problem, Greenway did not rectify the issue, allowing its users to collect inappropriate incentive payouts. Lastly, the government alleges that Greenway violated the Anti-Kickback Statute, a law meant to protect consumers by prohibiting the exchange of money for medical referrals.

Despite denying the allegations, Greenway agreed to the $57.25 million settlement, as well as several other terms, including giving their existing customers either a free upgrade to their newest electronic healthcare software or allowing them to transfer their data to another company’s software.

About the False Claims Act and Anti-Kickback Statute

The False Claims Act is a federal law that holds companies and people, often government contractors, accountable for defrauding government programs such as Medicare and Medicaid. The law also includes a provision allowing non-governmental entities to file lawsuits on behalf of the government. This provision is known as a qui tam or whistleblower provision and it protects employees who “blow the whistle” or turn in their employers for fraudulent activities.

Whistleblowers are often an integral part of discovering healthcare fraud and other crimes against the government.

The Anti-Kickback Statute is meant to prevent healthcare professionals from offering compensation or other benefits in exchange for referrals. The statute allows the government to penalize corporations or individuals who offer incentives for Medicaid or Medicare referrals.

If you have evidence that your employer may be committing healthcare fraud against the United States government, you may be eligible to join a whistleblower investigation.