Becker's Spine Review

January_February Issue of Beckers Spine Review

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35 HEALTHCARE NEWS ADVERTISINGINDEX Note: Ad page number(s) given in parentheses ADVERTISER ChoiceSpine. / / (865)246-3333 (pg. 3) DSM. / / (484)713-2100 (pgs. 12-17) Echelon Medical Capital. / www.echelonmedicalcapital. com / (888)943-1031 (pg. 36) Haag-Streit. / (855)854-5810 (pg. 2) K2M. / (866)526-4171 (pg. 32) Medtronic. / (800)633-8766 (pgs. 21-24) National Medical Billing Services. / www. / (866)948-7673 (pg. 5) Pacira Pharmaceuticals, Inc. / (855)793-9727 (pgs. 27-28) Zavation. / / (601)919-1119 (pg. 9) Lawsuit: Epic's Software Double-Bills Medicare, Medicaid for Anesthesia Services By Ayla Ellison H ealth IT giant Verona, Wis.-based Epic Systems has been hit with a False Claims Act lawsuit that alleges the company's soware double-bills Medi- care and Medicaid for anesthesia services, resulting in the government being overbilled hundreds of millions of dollars. e lawsuit, which was filed under the qui tam provision of the False Claims Act in 2015 and made public Nov. 2, alleges Ep- ic's billing soware's default protocol is to charge for both the applicable base units for anesthesia provided on a procedure as well as the actual time taken for the procedure. is results in the provider being reim- bursed twice for the base unit component, according to the lawsuit. According to the lawsuit, Medicare adjusted its payment approach to anesthesia services in 2012 to require physicians to bill for the ac- tual time on a procedure instead of 15-minute blocks of time. e suit alleges Epic's soware allowed hospitals to set up their anesthesia billing modules to bill for 15-minute incre- ments in addition to the actual time anesthe- siologists spent on the procedure. e whistle-blower who filed the lawsuit, Geraldine Petrowski, worked at Raleigh, N.C.-based WakeMed Health from Sep- tember 2008 through June 2014. In her role as supervisor of physician's coding, Ms. Petrowski served as the hospital liaison for Epic's implementation of its soware at WakeMed Health. Ms. Petrowski claims she provided examples to Epic representatives illustrating the dou- ble-billing practice, and the company initially ignored her complaints. "It was only aer re- lator, Petrowski, reiterated her direction to fix this soware setting that [Epic] relented and fixed it only for the WakeMed Health facility," according to the lawsuit. The lawsuit alleges the unlawful billing protocol has resulted "in the presentation of hundreds of millions of dollars in fraud- ulent bills for anesthesia services being sub- mitted to Medicare and Medicaid as false claims." In a statement to Healthcare IT News, an Epic spokeswoman said, "e plaintiff 's assertions represent a fundamental misunderstanding of how claims soware works." e Department of Justice declined to inter- vene in the case, and the whistle-blower will move forward in the case without the govern- ment. n The 10 Largest Health Insurance Companies by Membership By Eric Oliver Insider Monkey compiled the 10 largest U.S. health insur- ance companies by total enrollees. Here are the top 10 from most members to fewest members. 1. UnitedHealthcare Group, 70 million members 2. Anthem, 39.4 million members 3. Aetna, 23 million members 4. Health Care Services Corp., 15 million members 5. Cigna, 14.7 million members 6. Humana, 14.23 million members 7. Centene Corp., 11 million members 8. Kaiser Permanente, 10.7 million members 9. Highmark, 5.3 million members 10. WellCare Health Plans, 3.68 million members n

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