Florida judge dismisses lawsuit alleging Epic's software double-billed for anesthesia services

A Florida district court judge tossed out a lawsuit against Epic that alleged its software double-billed the government for anesthesia services.

The complaint was filed in 2015 under the qui tam provision of the False Claims Act by former Raleigh, N.C.-based WakeMed Health supervisor of physician's coding Geraldine Petrowski. She claimed Epic's billing software caused "hundreds of millions of dollars" in fraudulent payments from Medicare and Medicaid. The lawsuit wasn't unsealed until November.

In his dismissal, U.S. District Judge James Moody Jr. argued Ms. Petrowski parroted language in the False Claims Act without actually pointing to specific allegations. He wrote that Ms. Petrowski asserted "that Epic purportedly 'made false representations about [its] software' and 'presented or caused to be presented, a false or fraudulent claim for payment ...' '[a]s set forth above.' Yet, there are no allegations 'set forth above' of representations by Epic about its software, let alone misrepresentations to anesthesia providers or the government. Nor are there any credible allegations that any false or fraudulent claim was submitted to Medicare."

According to the lawsuit, the software's default protocol is to charge for both the applicable base units for anesthesia provided on a procedure and the actual time taken for the procedure, resulting in the provider being reimbursed twice for the base unit component. However, Judge Moody wrote in his dismissal Ms. Petrowski did not present evidence this was actually occurring.

He added that Ms. Petrowski failed to amend her complaint or add additional details after Epic moved to dismiss the lawsuit in December.

"[Ms.] Petrowski alleges only that Epic's software could be used in such a way that would allow its hospital customers to generate bills that cause the Medicare program to double pay for certain aspects of professional anesthesia services," Judge Moody wrote. "This is woefully deficient because it is based on pure speculation."

Epic spokesperson Meghan Roh hailed the decision as consistent with Epic's argument throughout the case. She told Becker's Hospital Review, "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."

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