The complaint alleges that Epic refused to adjust its billing software after the Centers for Medicare & Medicaid Services changed the way hospitals bill for anesthesia, prompting hospitals that use its software to improperly bill Medicare and Medicaid.
The whistleblower in the lawsuit, Geraldine Petrowski, worked as a compliance review specialist at WakeMed Health in North Carolina from September 2008 to September 2012 and then as the supervisor of physicians’ coding until June 2014. She also served as the liaison for the hospital’s Epic implementation, which went live in 2015.
Fierce Healthcare reports in January 2012, Medicare adjusted its reimbursement for anesthesia billing from 15-minute increments to the physician’s actual time on the procedure. But Petrowski claims Epic’s software allowed hospitals to bill for both the total time as well as the 15-minute increments, categorized as “base units.”
According to the lawsuit, when Petrowski raised concerns about the billing practice she was told “everybody bills base units.” She claims Epic eventually relented and fixed the software, but only for WakeMed Health.
HealthcareIT News quotes Petrowski:
This unlawful billing protocol has resulted in the presentation of hundreds of millions of dollars in fraudulent bills for anesthesia services being submitted to Medicare and Medicaid as false claims.
She also seeks to bolster her case, alleging that MD Anderson Cancer Center billed for seven hours of anesthesia for a prostate removal that took less than five hours.
Under the False Claims Act, defendants are liable for treble damages and civil penalties between $5,000 and $10,000 for each false claim.
Healthcare IT giant Epic Systems refutes the allegations.
Epic spokesperson Meghan Roh noted that the Department of Justice opted not to move forward with the case after “its own expert review” of the allegations and Fierce Healthcare quotes her:
The plaintiff’s assertions represent a fundamental misunderstanding of how claims software works.