Your Internet browser is outdated and cannot run this website. In order to view this site, and to protect your computer, please click to upgrade to a modern web browser of your choice:

Google Chrome or Mozilla Firefox

(Worry not– it's quick, safe and free, and you won't regret it!)

Recent Compliance Updates & Tips

View Our Article in PDF

  • This field is for validation purposes and should be left unchanged.
Strategic Management ×
Share This:
     

Lawsuit alleges hundreds of millions of dollars in overbilling

In 2015, a whistleblower filed a qui tam lawsuit against Epic Systems for violating the False Claims Act, alleging that Epic caused the billing systems to double-bill the government for anesthesia services. The plaintiff-whistleblower (“Relator”), Geraldine Petrowski, worked at WakeMed Health in Raleigh, North Carolina between 2008 and 2014 and served as the liaison for the hospital’s Epic implementation. Petrowski alleges that the billing system overbilled the government for hundreds of millions of dollars. The Department of Justice declined to intervene in the case. However, the Relator has decided to move forward without the government, resulting in the case becoming public. As hospital liaison for the Epic implementation, Petrowski claims to have observed “major concerns” about incorrect billing. These concerns led to Epic billing software defaults that charged for both the applicable anesthesia “base units” provided on a procedure and the actual time taken for the procedure. As a result, payors were overcharged for anesthesia. According to the complaint filed, Medicare adjusted its payment approach to anesthesia services in 2012 to require physicians to bill for the actual time on a procedure instead of 15-minute blocks of time reflected within the “base units.” The Relator stated she provided examples to Epic representatives that illustrated the double-billing practice, and the company initially ignored her complaints. Epic agreed to fix the software after forcing the issue, but only for the WakeMed Health facility.

Avoid Getting Hit With A Compliance Lawsuit.

Connect with a Compliance Consultant Today

Looking for A Compliance Evaluation?

Creating an effective and successful compliance program can be tough, especially within the healthcare industry. The consultants at Strategic Management Services have decades of experience designing and assessing compliance programs of all kinds. If you’re looking for any type of compliance program services, including internal review services, contact our experts online, or give us a call at (703) 683-9600 to speak with someone today.

Share This:
     
[class^="om-col-"]
[class^="om-col-"]
[class^="om-col-"]
[class^="om-col-"]
[gravityform id=30 title=false description=false ajax=true tabindex=49]