Federal EHR Incentive Grant Recipient Outreach Program
Conducted in alignment with CMS and the OIG audit compliance initiatives
To update your CMS file before the July 1st documentation deadline:
Connect with a certified resource officer to complete your Audit Preparedness Assessment and file update.
CMS and the OIG are jointly enforcing audit activity across all EHR grant recipients in 2025
Failure to update certification status may result in documentation requests, recoupment, or audit escalation
Updates are filed directly to reflect current certification status ahead of the July 1 deadline
WHY THIS MATTERS
This communication was issued based on a verified CMS recipient file reflecting a non-certified or unverified status. Technology Compliance Partners is a compliance resource and audit-preparedness vendor actively updating grant recipient files to meet CMS audit documentation requirements.
US Attorney General's focus on healthcare fraud, including EHR fraud, in 2025
1. Continued Focus on Healthcare Fraud Enforcement:
The Department of Justice (DOJ) continues to prioritize healthcare fraud enforcement, which includes electronic health record (EHR) related fraud.
In the federal government, leadership has a strong focus on healthcare fraud enforcement is expected to continue.
Specific concerns regarding EHR-related payment fraud have been raised by the Department of Health and Human Services (HHS) and the Department of Justice.
2. DOJ Whistleblower Program:
The revised 2025 DOJ Whistleblower Program guidance encourages reports related to healthcare fraud involving public health care programs.
Tips concerning "fraud against patients, investors, and other non-governmental entities in the health care industry" may also qualify for recovery under certain conditions.
The DOJ intends to investigate tips received through the program swiftly to promote its success.
3. State-Level Enforcement:
California's Attorney General is actively pursuing cases involving Medicaid fraud, including those potentially related to the use of EHR systems for improper invoicing.
Other states like Ohio and Florida have also reached significant settlements in healthcare fraud cases, indicating a multi-pronged approach to combatting fraud.
4. Cases and Settlements:
Several settlements have been reached in healthcare fraud cases, including a $3.61 million settlement with a non-profit and affiliated nursing homes, a $62 million settlement with L3 Technologies Inc. for false claims, and a $615,000 settlement with a Florida ophthalmology practice for fraudulent claims to Medicare and Medicaid.
A previous case in 2023 involved an EHR vendor, NextGen Healthcare Inc., settling a False Claims Act case for $31 million, where the government alleged their EHR lacked required functionalities that contributed to false claims.
In summary, the US Attorney General and the Department of Justice are actively pursuing healthcare fraud cases, including those potentially involving EHRs. They are also encouraging whistleblowers to come forward with relevant information.