eClinicalWorks Problems in 2026: $155M Fraud Settlement, OIG Safety Concerns, and Ongoing Compliance Issues

Overview of regulatory and compliance issues

This analysis is based on federal court records, Department of Justice press releases, Office of Inspector General reports, and investigative journalism from Healthcare IT News, Fierce Healthcare, and Phillips & Cohen LLP. We have organized the documented issues chronologically and by category.

Important context: eClinicalWorks remains a widely used EHR with a large installed base and broad feature set for ambulatory practices. The issues documented here are matters of public record involving federal enforcement actions, court filings, and regulatory oversight — not user opinion. Organizations evaluating eClinicalWorks should weigh these compliance and safety concerns against the platform's feature capabilities.

Regulatory timeline

The eClinicalWorks compliance record spans nearly a decade of federal enforcement activity. Here is the documented timeline:

$155M DOJ fraud settlement

In 2017, eClinicalWorks agreed to pay $155 million to settle a lawsuit brought by the Department of Justice under the False Claims Act. This was one of the largest EHR-related settlements in U.S. history.

The government's case alleged that eClinicalWorks:

• Knowingly falsified its meaningful use certification — the software did not meet the certification criteria it claimed to satisfy
• Misrepresented software capabilities to the Office of the National Coordinator for Health IT (ONC) during the certification process
• Enabled fraudulent incentive payments — healthcare providers relied on the false certification to receive federal EHR incentive payments they would not otherwise have qualified for

The case was initiated by a whistleblower, Brendan Delaney, a New York City employee who identified discrepancies between eClinicalWorks' claimed capabilities and its actual software performance. The settlement required eClinicalWorks to pay $155 million and enter into a five-year Corporate Integrity Agreement with the Office of Inspector General.

As Healthcare IT News reported, this settlement raised fundamental questions about the reliability of EHR certification processes and the trustworthiness of software that physicians depend on for patient care.

$999M class-action lawsuit

Less than six months after the DOJ settlement, eClinicalWorks faced a $999 million class-action lawsuit. As reported by Fierce Healthcare, the class-action alleged that software deficiencies were so severe that patients could not rely on the accuracy of their medical records.

This is an extraordinary allegation. The fundamental purpose of an electronic health record is to be a reliable source of truth for a patient's medical history. When a class-action alleges that the record itself cannot be trusted, it implicates every clinical decision made using that system.

Alleged software deficiencies

Court filings across the DOJ case and class-action lawsuit identified specific categories of software failures:

The medication module errors are particularly concerning from a patient safety perspective. Wrong dosages, missed medications, and duplicate orders are precisely the types of errors that EHR systems are designed to prevent. When the EHR itself introduces these errors, it undermines the core safety promise of electronic health records.

The audit log failures are equally significant from a compliance perspective. Audit logs are a foundational requirement for HIPAA compliance and are essential for investigating potential breaches, tracking record access, and maintaining chain-of-custody for medical documentation.

OIG patient safety concerns (2025)

In 2025 — nearly eight years after the original DOJ settlement — the Office of Inspector General took the unusual step of imposing additional compliance obligations on eClinicalWorks. As reported by Phillips & Cohen LLP, the OIG cited "significant concerns regarding patient safety issues" and eClinicalWorks' compliance with its original settlement obligations.

This is notable for several reasons:

• Duration of concern: The OIG was still identifying patient safety issues nearly a decade after the initial $155M settlement — this is not ancient history
• Settlement compliance failures: The OIG's action suggests that eClinicalWorks had not fully satisfied the terms of its original Corporate Integrity Agreement
• Ongoing regulatory risk: Organizations using eClinicalWorks face potential downstream compliance exposure if the platform's certification and safety issues affect the quality of care documentation

For behavioral health organizations in particular — where medication management (including controlled substances), treatment documentation accuracy, and regulatory compliance are especially high-stakes — ongoing OIG concerns about an EHR vendor represent meaningful operational risk.

Data portability failures

One of the terms of the 2017 DOJ settlement required eClinicalWorks to allow customers to transfer their data to other systems. However, Healthcare IT News reported that eClinicalWorks was not complying with these settlement terms, leaving clients "out in the cold" and unable to switch to alternative EHR vendors.

Two eClinicalWorks customers specifically reported that data transfer options and faulty software are "still problematic today" despite the settlement obligations. This creates a particularly troubling dynamic:

• Vendor lock-in through non-compliance: Customers who want to leave because of safety and compliance concerns cannot easily extract their data
• Regulatory obligations unfulfilled: Data portability was an explicit condition of the DOJ settlement, not an optional feature
• Patient care continuity risk: When practices cannot transfer patient records reliably, transitions of care are compromised

What to look for in an alternative

If the regulatory and compliance concerns documented above are relevant to your organization, here are the capabilities to prioritize when evaluating alternative EHR platforms:

• Clean regulatory compliance record — no federal enforcement actions, DOJ settlements, or OIG oversight obligations
• Reliable data portability — standard export capabilities in structured formats (CCDA, CSV) with no vendor lock-in or settlement-mandated requirements
• Verified patient safety record — no documented medication module errors, audit log failures, or federal patient safety concerns
• Valid ONC certification — current certification without a history of falsification allegations
• Accurate medication management — reliable dosage display, interaction checks, and e-prescribing (EPCS) for controlled substances
• Behavioral health specialization — if your organization serves behavioral health populations, look for native support for group therapy notes, UB-04 facility billing, and integrated clinical workflows
• Transparent audit logging — compliant audit trails that meet HIPAA requirements without supplementary workarounds

For a detailed comparison of platforms built for behavioral health, see our behavioral health EHR comparison.

Who should stay with eClinicalWorks

Despite the regulatory and compliance concerns documented here, eClinicalWorks may still be the right choice for certain organizations:

• Large multi-specialty groups that have heavily customized the platform over many years and have dedicated IT teams managing the system
• Organizations with deep workflow integration where the cost and disruption of switching would be significant, and the compliance risks can be managed through internal controls
• Practices with dedicated compliance officers who can independently monitor regulatory developments and maintain supplementary audit processes

However, if you are a behavioral health organization evaluating EHR options — particularly one handling controlled substances, operating at the facility level, or subject to heightened regulatory scrutiny — the documented pattern of federal enforcement, patient safety concerns, and data portability failures represents risk that must be factored into your vendor selection process.

For behavioral health organizations that need a clean compliance record, reliable medication management, data portability, and purpose-built clinical workflows, our behavioral health EHR comparison covers the platforms designed for these requirements.

Frequently asked questions

What was the eClinicalWorks DOJ settlement about?

In 2017, eClinicalWorks paid $155 million to settle allegations by the Department of Justice that the company knowingly falsified its meaningful use certification. The government alleged that eClinicalWorks misrepresented the capabilities of its software, enabling healthcare providers to receive federal incentive payments they were not entitled to.

What patient safety concerns has the OIG raised about eClinicalWorks?

In 2025, the Office of Inspector General imposed additional compliance obligations on eClinicalWorks due to "significant concerns regarding patient safety issues" and the company's compliance with its original settlement obligations. This indicated ongoing regulatory scrutiny nearly a decade after the initial DOJ settlement.

What software deficiencies were alleged in the eClinicalWorks lawsuits?

Lawsuits alleged multiple specific software deficiencies: failure to reliably record diagnostic imaging orders, failed audit log requirements, failed data portability requirements, and medication module errors including wrong dosages, errors with start/stop dates, duplicate orders, and failure to display current medications.

Can eClinicalWorks customers easily transfer their data to another EHR?

Data portability has been a persistent issue. Despite settlement obligations requiring eClinicalWorks to allow data transfers, Healthcare IT News reported that customers were "left out in the cold" with the vendor not complying with DOJ settlement terms. Customers have stated that data transfer options and faulty software are "still problematic today."

Editorial Standards

Last reviewed: February 25, 2026

Methodology

• Reviewed federal court records and DOJ press releases related to the 2017 settlement.
• Analyzed class-action complaint filings and alleged software deficiencies.
• Reviewed OIG compliance actions and patient safety communications (2025).
• Cross-referenced investigative journalism from Healthcare IT News, Fierce Healthcare, and Phillips & Cohen LLP.
• Acknowledged eClinicalWorks' broad installed base and feature capabilities for multi-specialty practices.

Primary Sources

• Healthcare IT News: eClinicalWorks $155M DOJ Settlement
• Healthcare IT News: Clients Left Out in the Cold
• Fierce Healthcare: eClinicalWorks Class-Action Lawsuit
• Phillips & Cohen: OIG Patient Safety Concerns