Judge tosses lawsuit alleging double-billing by Epic: ‘Based on pure speculation’

A federal judge in Florida has tossed out a lawsuit against Epic Systems, saying the plaintiff “parroted” the language of the False Claims Act without offering support for her claim that the company’s billing system software double-billed Medicare and Medicaid for anesthesia services.

The suit had been filed by Geraldine Petrowski, a former supervisor of physician coding at WakeMed Health in Raleigh, North Carolina, in 2015 and was unsealed in November 2017. She alleged Epic’s Resolute Billing Charge Capture system, had a default setting to charge for anesthesia services for both the “base units” to be reported on the claim form—which CMS had said shouldn’t be included—as well as the actual time a physician had taken on the procedure.

In dismissing the complaint, U.S. District Judge James Moody Jr. said Petrowski failed to make credible allegations—like offering examples of a false claim submitted to Medicare or how Epic supposedly misrepresented the software’s capabilities. One of her exhibits was just a list of hospitals and health systems which use the software.

“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,” Moody wrote. “This is woefully deficient because it is based on pure speculation.”

Epic had denied the allegations went the suit was unsealed, pointing out the U.S. Department of Justice had declined to join the case.

“As we previously stated, the plaintiff’s assertions represented a fundamental misunderstanding of how claims software works,” Epic spokesperson Meghan Roh said in a statement to HealthExec. “We are pleased the court dismissed this case.”