A lawsuit filed against Epic Systems, a digital health care records company based in Verona, Wisconsin, alleges the company systematically overbilled the government for Medicare and Medicaid.
The lawsuit was initially filed under the False Claims Act (FCA) in 2015 by Geraldine Petrowski, a former employee for a health care company in North Carolina. Under the False Claims Act, all lawsuits filed by whistleblowers are sealed until the Department of Justice can investigate the allegations. In this case, the allegations were kept quiet for more than two years until the federal court unsealed the documents.
Epic develops medical records software that enables hospitals to select how they will itemize bills for anesthesia. According to the lawsuit, the software allows healthcare providers to essentially double their reimbursements for a single anesthesia service.
Petrowski worked as a liaison between her healthcare organization, WakeMed, and Epic. She shared her discovery with Epic, and the company removed it for WakeMed. However, according to her complaint, the feature remains in place in other health systems used across the country.
There are different ways to measure how long a patient remains under anesthesia. Some health care providers charge anesthesia using “units” of 15 minutes, while others charge based on total minutes under anesthesia. According to the complaint, the feature implemented by Epic allows hospitals to add units to minutes, which results in double-charging payers for those treatments.
Petrowski claims this is an unlawful method of billing and has resulted in hundreds of millions of dollars of fraudulent Medicare and Medicaid billing.
Any whistleblowers are allowed to file lawsuits on behalf of the federal government and can receive a portion of any funds recovered in the case. To learn more about how to proceed with a False Claims Act case, contact an experienced Dallas attorney at Kardell Law Group.