A newly unsealed Florida whistleblower lawsuit alleges software used at more than 300 hospitals is leading them to overbill Medicare and Medicaid.
Epic Systems Corp.’s software does not comply with 2012 guidelines for counting the number of minutes a patient is under anesthesia, claims the Tampa federal lawsuit unsealed Nov. 2. Instead, the software bills for the number of predetermined 15-minute “base units” linked to a certain billing code and then adds the full amount of time the patient was under anesthesia, whistleblower Geraldine Petrowski alleges.
“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,” claimed Petrowski, a North Carolina resident who worked as a health care billing specialist.
Wisconsin-based Epic has 8,000 employees, and its customer hospitals hold medical records for 54 percent of patients in the country, according to the lawsuit. In South Florida, Epic’s software is used at the University of Miami Health System, Memorial Healthcare System, Mount Sinai Medical Center and Leon Medical Centers, the lawsuit claims.
The whistleblower claim was filed under seal in June 2015 by Palm Harbor attorney David Linesch of the Linesch Firm, who did not respond to an interview request. The government declined to intervene in the case.
“The Department of Justice did its own expert review and decided not to move forward,” Epic spokesperson Meghan Roh said in an email. “The plaintiff’s assertions represent a fundamental misunderstanding of how claims software works.”
Petrowski was helping implement Epic’s software for her then-employer WakeMed Health in Raleigh, North Carolina, when she noticed the alleged double-billing. After she complained repeatedly, Epic changed the software—but only for WakeMed, she claims.
According to the lawsuit, other hospitals are still submitting false claims. For instance, Petrowski reviewed a bill for a Texas patient that counts 28 “base units” of 15 minutes, which amounts to seven hours of anesthesia. But the time record shows the patient was only under anesthesia for four hours and 49 minutes, or 19 units, she alleges.
The nine extra units come in because the number of base units assigned to the patient’s procedure in the Current Procedural Terminology code is seven. Two units were likely tacked on for the time before and after the anesthesia was in effect, Petrowski alleges.
The South Florida hospitals listed as users of Epic’s software did not respond to requests for comment by deadline. They are not defendants in the lawsuit.
Epic is represented by John Guard of Quarles & Brady in Tampa, and the case is before U.S. District Judge James Moody in Tampa.