In a newly unsealed lawsuit, allegations have been made against Epic Systems claiming their billing software allowed hundreds of hospitals to double-bill Medicare and Medicaid for anesthesia services. These could have resulted in hundreds of millions of dollars in improper claims.

Plaintiff Geraldine P. is spearheading this healthcare fraud lawsuit. She worked as a supervisor of physician coding at WakeMed Health between 2008 and 2014 in Raleigh, N.C.

While at WakeMed, she was trained in 2012 on Epic System’s Resolute Billing Charge Capture system. However, according to her healthcare fraud lawsuit, she found out in 2015 that Epic had not upgraded the Resolute Billing software to 2012 standards on how to bill Medicare and Medicaid for anesthesia services provided.

The healthcare fraud allegations purport that in January 2012, Medicare changed from allowing 15-minute increments in anesthesia services to be billed for reimbursement purposes to only allowing a physician’s actual time in providing the service to be billed.

What Epic’s software system did was to allow hospitals to bill not only for the actual time for which the physician conducted the service but the 15-minute allotted increment time as well. This is what is defined as a “base unit.”

The issue, according to the healthcare fraud allegation, is that the system is defaulted to charge for both base units. Both the charge and the exact time a physician takes on an anesthetic service are noted on the claim form.

Geraldine then notified Epic of the issue that she had discovered. What Epic advised her, however, was that hospitals are billing base units and that other systems are built in this same way.

Allegations, however, maintain that Epic simply altered WakeMed’s Resolute Billing system, but other hospitals that are using the company’s billing service are still double billing both Medicare and Medicaid.

The healthcare fraud lawsuit includes a bill from MD Anderson Cancer Center. The bill purportedly shows the center billed for seven hours of anesthesia services for a prostate removal, when the actual time it took to conduct the service was less than five hours.

The healthcare fraud being alleged against Epic Systems allegedly resulted in hundreds of millions of dollars in fraudulent bills. Under the False Claims Act, Epic Systems could be liable for $10,000 in penalties and damages for each false claim that they had submitted.

In this particular case the U.S. Department of Justice has declined to join the lawsuit. The plaintiff’s attorney advise that they plan to move forward with the case despite the DOJ’s decision not to intervene.

The healthcare fraud allegations are said to affect nearly 300 hospitals, physician practices, and health systems.