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Attorney General announces more than $170,000 returned to Medicaid program as part of multistate agreement

Attorney General Daniel Cameron announced that the Office of Medicaid Fraud and Abuse Control returned more than $170,000 to the state’s Medicaid program as part of a multistate agreement with web-based electronic health records company Practice Fusion, Inc.

The agreement settles allegations that the company accepted payments from specific drug manufacturers in exchange for promoting the same manufacturers’ drugs to physicians using Practice Fusion’s software.

Practice Fusion promoted drugs to physicians using pop-up notifications in the company’s software. These notifications suggested a particular drug be considered as physicians evaluated patients’ medical histories.

Daniel Cameron

The settlement resolves allegations that the payments accepted by Practice Fusion constitute kickbacks in violation of the federal Anti-Kickback Statute and Civil Monetary Penalties Law and related Kentucky statutes.

Practice Fusion has agreed to pay a total of $118,642,000 to resolve civil fraud allegations impacting Medicaid and other government healthcare programs. Of this total, $5,267,048 will go to the state Medicaid programs and Kentucky’s program will receive $170,000 commensurate with false Medicaid claims filed in Kentucky.

The civil settlement resolves allegations that from November 2013 through August 2017, Practice Fusion solicited and received improper remuneration from certain pharmaceutical manufacturers based on the anticipated financial benefit from increased sales of drugs that would result from clinical decision support (CDS) alerts deployed by Practice Fusion within its EHR software platform.

Pharmaceutical manufacturers that paid Practice Fusion selected guidelines used to develop the alert, set criteria that would determine when a provider received an alert, and in some cases, even drafted the language used in the alert itself.

The CDS alerts did not always reflect accepted medical standards, and although they appeared to provide unbiased medical information, the CDS alerts were designed to encourage providers to prescribe a specific drug or class of drugs in some instances.

Practice Fusion’s actions served as an inducement to promote the same companies’ drugs through CDS alerts in violation of the AKS. This behavior resulted in false claims or information being submitted or presented to the Kentucky Medicaid program for reimbursement. This settlement covers 14 separate CDS alert agreements entered into during the relevant time frame.

Learn more about the Kentucky Office of Medicaid Fraud and Abuse here.

From Office of Attorney General Daniel Cameron

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