Verona, Wisconsin-based Epic has been hit with a False Claims Act lawsuit, which alleges the vendor’s software double-bills Medicare and Medicaid for anesthesia services.
This has resulted in “hundreds of millions of dollars” in overbilling, according to the suit, which was originally filed in 2015 and unsealed late last week.
It claims Epic did not alter its billing software after the Centers for Medicare and Medicaid Services changed how hospitals bill for anesthesia services. The vendor’s software charges for the applicable “base units” (or 15-minute segments) on a procedure as well as the physician’s actual time spent on a procedure, according to the lawsuit.
“As a result of this nationwide scheme, Defendant reaped profits far beyond those they would have achieved from legitimate promotion of its business,” according to the suit.
Geraldine Petrowski, a former employee of Raleigh, North Carolina-based WakeMed Health, filed the complaint. From September 2008 to September 2012, she worked as a compliance review specialist. Between September 2012 and June 2014, Petrowski was the supervisor of physician’s coding and served as the liaison for WakeMed’s Epic installation.
The complaint claims that when Petrowski voiced these billing-related concerns, Epic initially ignored them but eventually fixed the problem for WakeMed only. The suit also alleges MD Anderson Cancer Center billed for seven hours of anesthesia for a prostate removal that took less than five hours.
“The plaintiff’s assertions represent a fundamental misunderstanding of how claims software works,” Epic spokesperson Meghan Roh said in an emailed statement.
Roh added that the Department of Justice conducted “its own expert review and decided not to move forward.”