Health Care Software Double-Bills Government For Anesthesia Services According to FCA Suit

George IndestBy George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law

On November 2, 2017, a relator in a Florida federal False Claims Act (FCA) case, claimed that Epic Systems’ (Epic) health software wrongly defaults to double-billing for anesthesia services. As a result, the government is being overbilled by hundreds of millions of dollars, according to relator Geraldine Petrowski.

The Relator’s Allegations.

In an amended complaint, the relator alleges Epic billing software, used by hundreds of hospitals in the United States, defaults to charging for both the applicable “base units” for anesthesia provided on a procedure, as well as the actual time taken for the procedure. “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,” Petrowski said.

The relator served as WakeMed Health’s hospital liaison for the health care system’s implementation of Epic’s software in 2014. It was during that time in which she came across the anesthesia billing issues, and developed “major concerns” about incorrect billing, she said.

According to the complaint, she met with representatives of Epic to point out the double-billing issue, but was told that the issue is present in all other similar systems and that “everyone bills base units.” Following the meeting, Epic failed to correct its billing software, making it probable that at least most of its customers are continuing to double-bill for anesthesia services.

To read the amended complaint in full, click here.

False claims are a growing problem costing the government billions of dollars each year, and the government is not shy about striking back. Punishments for defrauding the system can be quite severe. To learn more about a similar case of overbilling, click here to read one of my prior blogs.

Contact Health Law Attorneys Experienced with Qui Tam or Whistleblower Cases.

Attorneys with The Health Law Firm also represent health care professionals and health facilities in qui tam or whistleblower cases both in defending such claims and in bringing such claims. We have developed relationships with recognized experts in health care accounting, health care financing, utilization review, medical review, filling, coding, and other services that assist us in such matters. We have represented doctors, nurses and others as relators in bringing qui tam or whistleblower cases, as well.

To contact The Health Law Firm, please call (407) 331-6620 or (850) 439-1001 and visit our website at www.TheHealthLawFirm.com.

Sources:

Wilson, Daniel. “Epic’s Software Double-Bills Gov’t For Anesthesia: FCA Suit.” Law360. (November 2, 2017). Web.

Fisher, John. “Agressive Anesthesia Billing Advice Can Be Costly.” Ruder Ware Health Law Blog. (January 12, 2012). Web.

About the Author: George F. Indest III, J.D., M.P.A., LL.M., is Board Certified by The Florida Bar in Health Law. He is the President and Managing Partner of The Health Law Firm, which has a national practice. Its main office is in the Orlando, Florida, area. www.TheHealthLawFirm.com The Health Law Firm, 1101 Douglas Ave., Altamonte Springs, FL 32714, Phone: (407) 331-6620.

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