NextGen Healthcare Settles False Claims Case for $31 Million Amid Violations

NextGen Healthcare has agreed to pay $31 million to settle allegations of violating the False Claims Act and the Anti-Kickback Statute. The U.S. Department of Justice (DOJ) filed a complaint stating that NextGen credited customers whose recommendations of its software led to new business, a practice that violated federal laws. The settlement emphasizes the importance of compliance officers in preventing such misconduct.

The DOJ's press release on Friday highlighted NextGen's actions between January 2011 and July 2017, during which the company provided credits worth as much as $10,000 to customers who referred new business to them. This practice was deemed a violation of the False Claims Act and the Anti-Kickback Statute. NextGen's software certification process, required to meet criteria published by the Department of Health and Human Services (HHS) in 2014, also came under scrutiny in the DOJ's complaint.

Implications for Compliance Officers

Principal Deputy Assistant Attorney General Brian M. Boynton, who heads the Justice Department's Civil Division, emphasized the critical role electronic health records (EHR) play in the healthcare system. He stressed the importance of protecting the integrity of EHR software and the selection process for healthcare providers. The allegations against NextGen raise concerns about the accuracy and reliability of health information transmitted through EHR systems.

1. Ensure Accurate and Transparent Certification Processes: Compliance officers should review and strengthen certification processes to ensure that all criteria are met transparently. Companies developing and marketing EHR technology must demonstrate that their product satisfies applicable HHS-adopted certification criteria, including identifying any software components relied upon to perform the criteria. Rigorous testing by independent, accredited entities is crucial to maintain the integrity of the certification process.
2. Prohibit Inducements and Kickbacks: Compliance officers must enforce policies and procedures that strictly prohibit inducements and kickbacks in accordance with the Anti-Kickback Statute. It is vital to educate employees and stakeholders about the legal implications and potential consequences of offering or accepting remuneration to influence referrals or purchases covered by federal healthcare programs.
3. Implement Robust Compliance Monitoring and Reporting Systems: Compliance officers should establish comprehensive monitoring and reporting systems to detect and address any potential violations promptly. Regular audits, internal controls, and employee training programs are essential to ensure adherence to legal and regulatory requirements. Compliance officers should foster a culture of compliance throughout the organization and provide channels for reporting concerns or potential violations.

The NextGen Healthcare case serves as a reminder of the importance of compliance officers in promoting ethical practices and preventing violations that could lead to legal and financial consequences. By implementing robust compliance measures, organizations can uphold the integrity of the healthcare industry and maintain public trust in their services.

It is crucial for all companies operating in the healthcare sector to learn from this settlement and take proactive steps to ensure compliance with applicable laws and regulations governing EHR technology and referral practices.