Epic Health Care Fraud Lawsuit Alleged by Whistleblower

A whistleblower has lodged a lawsuit against digital health care records company, Epic Systems, alleging that over billing for Medicare and Medicaid are the basis of her fraud allegations.

The Epic health care fraud case was initiated by a former employee of the health care system located in North Carolina. The lawsuit alleges that Epic’s medical billing system allowed hospitals to fraudulently bill Medicaid and Medicare.

Epic Health Care Fraud Prompts False Claims Act Case

medical billsThe lawsuit was filed in 2015 under the False Claims Act.  The U.S. government uses the False Claims Act as their primary mechanism for combating fraud. Whistleblower claims are kept under seal while the government Department of Justice investigates the allegation. A federal court only recently unsealed the documents in this Epic health care fraud case as a result of those claims.

Software Used to Double-Bill or Overbill for Anesthesia Procedures

Allegedly, Epic’s medical record software allows hospitals to choose how they will itemize anesthesia bills. The software will allow a health care provider to be reimbursed twice for the same anesthesia services, according to the whistleblower who brought forth the claim. The whistleblower reported that she alerted Epic about the billing feature for anesthesia and that it was eventually removed. However, she alleges that this same feature is built into numerous other healthcare systems across the country.

According to the complaint, the billing protocol specifics have to do with measuring the length of time that a patient is under anesthesia. Certain health care providers may charge based on total minutes while others will use 15 minute units to calculate charges for anesthesia.

The Epic health care fraud lawsuit alleges that their software allows hospitals to add units to minutes. As a result, hospitals were able to double charge for anesthesia.

The whistleblower complaint argued that this illegal billing protocol led to hundreds of millions of dollars’ worth of fraudulent bills for anesthesia services being submitted as false claims to Medicaid and Medicare.

Whistleblowers are enabled to bring lawsuits on behalf of the government and may be entitled to a portion of recovered funds under the False Claims Act. While the whistleblower is usually an insider like an employee who has clear knowledge of the alleged behavior, any allegation of fraud prompts the Department of Justice to conduct an investigation to determine whether or not to intervene. As with many other allegations of health care fraud in the United States, the government may opt to get involved in the investigation or not based on evidence shared by a whistleblower.

According to court documents, the Department of Justice informed Epic in February that it did not intend to act on the lawsuit. Even when the Department of Justice arrives at this decision, however, the original whistleblower is still empowered to bring forward a case. This Epic health care fraud lawsuit may include a great deal of money inappropriately billed to Medicaid and Medicare.

If you believe that you have grounds for a whistleblower claim, consulting with an experienced attorney is vital. Call Bradley/Grombacher today for a consultation. 

Note: Bradley/Grombacher is not representing the plaintiff in this lawsuit.