A whistle-blower has alleged that Epic Systems Corp.'s billing software double-bills Medicare and Medicaid for anesthesia, violating the False Claims Act.
In a complaint filed in 2015 and unsealed on Thursday, Geraldine Petrowski alleged Epic's software bills for both the base units of anesthesia for a procedure and the time the procedure takes, resulting in overpayments to providers amounting to "hundreds of millions of dollars in fraudulent bills" submitted to payers, including Medicare and Medicaid.
Petrowski was a member of Raleigh, N.C.-based WakeMed Health & Hospitals' compliance team and worked with Epic as the provider's liaison for its software implementation from September 2012 to June 2014, according to the complaint.
She developed "major concerns" that Epic's software code created incorrect billing issues and alerted Epic that the coding violated Medicare and Medicaid regulations. But Epic initially dismissed her concerns and said "all other hospitals are billing base units," the complaint said.
After Petrowski persisted, Epic fixed the anesthesia billing issue for WakeMed only. Petrowski said she has reviewed a patient bill from MD Anderson Cancer Center that shows the same anesthesia billing issues. MD Anderson is an Epic software user hospital, according to the complaint.
"These Epic software-generated bills incorrectly and unlawfully include base units in bills for anesthesia services thereby resulting in double payment to the provider for base units for every anesthesia bill provided under ESC's Epic software billing system," the complaint said.
Epic noted that the U.S. Justice Department has reviewed Petrowski's case and declined to intervene.
"The plaintiff's assertions represent a fundamental misunderstanding of how claims software works," Epic spokesperson Meghan Roh said in a statement.
