Electronic health record systems that have been designed to add services that were not actually rendered are increasingly the target of U.S. Department of Justice attention using advanced analytics. The former owner of Aggeus Healthcare, its CEO and one of its lawyers received prison sentences in connection with a scheme to alter electronic records by adding information in order to enhance Medicare reimbursement.
In its indictment, the Department of Justice alleged that owner Dr. Yev Grey and Director of Corporate Legal Affairs Natalie Grey (yes, they’re married) conspired to defraud Medicare by creating an electronic health records system that “automatically inserted into the records symptoms and diseases the patient did not have,” and billed Medicare for those services between 2009 and 2015. The investigation was triggered by complaints from patients, nursing homes and even some of the podiatrists who worked for Aggeus.
CEO James Sayadzad was sentenced in September to one year in federal prison and was ordered to pay $1.78 million in restitution. Nancy Grey also received a one-year sentence and Dr. Yev Grey was sentenced to 90 months in prison and ordered to pay $6,974,895 in restitution.
A significant factor in the investigation was the nature of the information inserted into the patients’ records: it was identical. Equally important to counsel for any healthcare provider that uses electronic records (which is virtually all of them) is the government’s use of advanced analytics to review the suspect records and spot the identical nature of the added information.
One of the interesting side-effects of the nationwide transition to electronic health records is the relative ease in which governmental entities can obtain and review large volumes of records, using analytics and artificial intelligence, for compliance with federal and state standards and to investigate fraud and abuse. This can be done remotely, and so limitations on oversight resource personnel that inhibited such reviews in the days of paper records have been significantly cleared.
Counsel for healthcare providers should seriously consider advice to their clients to implement procedures to audit electronic health records for red flags such as repeated identical entries, “cut-and-paste” findings or symptoms and other anomalies that don’t appear to comport with treatment and diagnosis. A comprehensive understanding of the technology of the subject records system and how the government will apply advanced analytics in examining those records, as well as the clinical parameters of record-keeping, is essential to providing this advice.
If you have questions regarding internal audit and monitoring processes for electronic health records, or government requests to examine such records, please contact Kenneth N. Rashbaum.