Healthcare Kickback Scheme Whistleblower Leads to $45 Million Settlement

The former Vice President of Product Management at Modernizing Medicine, Inc., has led to a $45 million settlement for a healthcare kickback scheme. Amanda Long filed a whistleblower action in 2017, which was amended in May 2021. The company was found to have created a healthcare kickback scheme that violated the False Claims Act.

Case background

The company, called ModMed for short, is a privately owned vendor dealing in health information technology, like integrated electronic health record software. The DOJ found that ModMed violated the FCA and Anti-Kickback Statute (AKS) through three separate marketing programs.

The AKS prohibits anyone from “offering or paying, directly or indirectly, any remuneration — which includes money or any other thing of value — to induce referrals of items or services covered by Medicare, Medicaid and other federally funded programs.”

ModMed was found to have solicited and received kickbacks from another company in exchange for recommending their users patronize the other company’s pathology lab services. They also improperly donated their EHR to healthcare providers to increase lab orders and ModMed’s user base, and paid kickbacks to current provider customers and other sources, to recommend ModMed to potential customers.

They “submitted tainted claims for reimbursement to the federal health care programs for pathology services … and also submitted tainted claims for meaningful use incentive payments under the Medicare and Medicaid Electronic Health Record Incentive Programs…of the Centers for Medicare and Medicaid Services.”

These actions led to a settlement agreement in which ModMed does not acknowledge fault, but will still pay $45 million to resolve the action. In turn, the United States government will pay Amanda Long $9 million, plus interest, for her role in reporting the action.

If you’re ready to report an employer violation, a trusted whistleblower attorney at Kardell Law Group can help you navigate the process. Reach out today to learn more.