Law360 reports on a newly unsealed False Claims Act lawsuit against healthcare software company Epic Systems alleging that Epic has systematically overbilled the government for anesthesia services. The complaint, filed on behalf of the United States by relator Geraldine Petrowski in the United States District Court for the Middle District of Florida, alleges that Epic’s software charges both for the base units associated with anesthesia and the actual time the anesthetic administration procedure takes. The complaint alleges that this overbilling has resulted in hundreds of millions of dollars in fraudulent claims to Medicare and Medicaid.
The relator worked at WakeMed Health between 2008 and 2014 and served as a liaison for the group’s implementation of Epic software. During her time at WakeMed following the implementation of Epic, Petrowski came across the alleged anesthesia billing issues and became concerned about incorrect billing. Medicare changed its rules for billing anesthesia by switching from billing “units” to instead billing in actual minutes. This change meant that base units were not meant to be reported on Medicare forms.
The relator alleges that Epic’s software let hospitals include both the minutes worked and a base unit number for the procedure. The relator alleges that this was Epic’s default setting and that hospitals were in turn reimbursed twice for the same procedure. The relator brought her concerns to representatives of Epic and the company took out the double-billing factor out of WakeMed’s software. However, the relator alleges that Epic’s other customers likely continue to double-bill anesthesia services because they continue to allow a system where both the minutes and base units are included in billing.
The Department of Justice conducted its own investigation of the relator’s claims and chose not to intervene in the case. A spokesperson for Epic said in a statement that “the plaintiff’s assertions represent a fundamental misunderstanding of how claims software works.” This case demonstrates a continued fight against healthcare software companies in light of the settlement of an FCA case against eClinicalWorks back in May of this year.
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