FWA Briefs

Find news and solutions for healthcare payers and providers. Recognize and avoid potential fraud, waste, and abuse scenarios. Real-time clinical claim editing are analyzed to maximize provider reimbursements.

EHR systems can’t protect you from the False Claims Act

  • by John Danza
  • Aug 11, 2017, 10:15 AM

The recent Department of Justice (DOJ) $155 million False Claims Act settlement with eClinicalWorks highlights a problem that has existed in the EHR software industry for a long time.  Any EHR system that attests to do everything for the integrated health system can’t possibly provide the highest possible level of all aspects of functionality.  Some parts of the system will be concentrated upon while others will get just enough attention so the vendor can say they have the functionality, allowing them to “check the box” on your RFP.  The fact is that EHR vendors don’t have the strength of capabilities to fully safeguard their customers from submitting potentially inaccurate claims, exposing the customers to False Claims Act violations. 

Hospital systems and provider groups would be better served to modularize their processing rather than licensing a huge, and hugely expensive, monolithic, enterprise-wide system.  Modularization allows the health system to utilize the best software for each need within the health system.  Single-source, enterprise-wide processing systems don’t cut it anymore. 

As the OIG increases its oversight of activities that it perceives as placing patient safety at risk, it will be incumbent on health systems to vigorously identify aberrant care practices that will increase auditor and regulator scrutiny.  Having a generalist-type system that doesn’t specialize in identifying these types of aberrations open the health system up to increased risk, an increased number of audits, and greater financial impact. 

Context 4 Healthcare has spent the past three decades safeguarding health systems from false claims and high denial rates.  We specialize in this role, because it’s an important requirement for the health system in order for them to provide the best care for their patients and the best financial strength for their shareholders. Context is an expert extension of your compliance team. 

Context’s ClaimsEditor Online (CEO) solution is specifically designed to detect potential situations that might lead to false claims submission, ranging from fraud, waste, and abuse (FWA) issues, situations that would trigger audits by RACs, OIG, or commercial payers, all the way to simple billing oversight issues. CEO has thousands of pre-built rules within the solution, with new rules added constantly as FWA schemes emerge. 

Integration between CEO and your EHR system is easy.  CEO can be plugged in to your EHR through a variety of real-time or batch interface methods contained within the CEO solution.  CEO can meet your interface workflow needs. 

Don’t let your health system be exposed to financial risk and civil liabilities because you’re not using the best capabilities the industry has to offer.  Talk to Context 4 Healthcare today about how you can get started using ClaimsEditor Online to protect your company from False Claims Act violations. 

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