An electronic health records vendor was ordered to pay $145 million in damages and penalties for allowing drug companies to help create medical alerts in its software that push doctors toward prescribing more opioids, according to the Department of Justice.

San Francisco-based Practice Fusion both sought and received kickbacks from an opioid company, and in return, it allowed that company's marketing department to help craft alerts that influence physicians to prescribe potentially addictive opioids.

"Practice Fusion's conduct is abhorrent. During the height of the opioid crisis, the company took a million-dollar kickback to allow an opioid company to inject itself in the sacred doctor-patient relationship so that it could peddle even more of its highly addictive and dangerous opioids," Christina E. Nolan, U.S. attorney for the District of Vermont, said. "The companies illegally conspired to allow the drug company to have its thumb on the scale at precisely the moment a doctor was making incredibly intimate, personal, and important decisions about a patient's medical care, including the need for pain medication and prescription amounts."

Practice Fusion solicited "sponsorship" payments from drug companies, the DOJ said, and in exchange for those payments, Practice Fusion then allowed the drug companies to influence the process of creating clinical decision support alerts in its software.

Not only were the companies allowed input in setting the criteria for the CDS alerts to be sent to physicians, they were sometimes allowed to influence the actual text of those alerts — a shocking conflict of interest, considering the financial interest drug companies have in pushing their product.

Practice Fusion sold the arrangement to the drug companies explicitly by emphasizing the profitability of the scheme for the drug companies, who would have a chance to more than recoup their original investment. One opioid company paid Practice Fusion nearly $1 million.

In addition to the criminal aspect of the settlement, Practice Fusion will pay out millions in a civil settlement for concealing the fact that its software did not comply with all applicable certification requirements, and misled the certifying body in order to obtain the certification anyway.

Of the $145 million, Practice Fusion is paying $118.6 million in criminal fees and forfeitures, and $26 million to the federal government and state governments in civil settlements.