Florida District Court Judge said the plaintiff is lacking facts to backup the allegations that a glitch in Epic electronic health record software caused hundreds of millions of dollars in overbilling.
By Bernie Monegain
A U.S. District Court judge in Florida has rejected allegations that EHR giant Epic Systems broke the law by overbilling for anesthesia procedures.
The ruling comes as other EHR vendors, notably eClinicalWorks and Allscripts, have lawsuits filed against them.
The plaintiff in Epic’s case, Geraldine Petrowski, failed to meet the heightened pleading requirement for claims alleging fraud and was lacking facts, concluded Florida U.S. District Judge James S. Moody Jr.
“Petrowski does not allege any facts about the alleged misrepresentation, like whether it was oral or written, what it consisted of, who made it and to whom, when it was made, where it was made, what claim was actually submitted to Medicare, by whom it was submitted, or when it was submitted,” he wrote in his conclusion.
Epic spokeswoman Meghan Roh issued this statement: “As we previously stated, the plaintiff’s assertions represented a fundamental misunderstanding of how claims software works. We are pleased the court dismissed this case.”
In her suit, filed in 2015, Petrowski alleged that a glitch in the Epic billing system had resulted in hundreds of millions of dollars of overbilling.
Petrowski, who worked at WakeMed Health in Raleigh, N.C. between 2008 and 2014, filed the complaint, charging that Epic’s billing software 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, resulting in payers being overcharged for anesthesia.
“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 wrote in her complaint.
Had Petrowski prevailed, she might have been up for a whistleblower award from the government.
If the Justice Department enters a case begun by a whistleblower, prosecutes the case and wins, the whistleblower is entitled to a maximum of 25 percent and a minimum of 15 percent of any funds recovered by the government as a result of the verdict or settlement.
Petrowski served as hospital liaison for WakeMed’s rollout of Epic’s software, when she came across the anesthesia billing issues, developing “major concerns” about incorrect billing, she said in the complaint.
She worked as a compliance review specialist from September 2008 to September 2012 and then as the supervisor of physicians’ coding through May 2014. In 2015, she was the liaison for the hospital’s Epic go-live.