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HEALTHCARE
NEWS
ADVERTISINGINDEX
Note: Ad page number(s) given in parentheses
ADVERTISER
ChoiceSpine. info@choicespine.com / www.choicespine.com / (865)246-3333
(pg. 3)
DSM. info@dsm.com / www.dsm.com/spine / (484)713-2100 (pgs. 12-17)
Echelon Medical Capital. info@echelon.us / www.echelonmedicalcapital.
com / (888)943-1031 (pg. 36)
Haag-Streit. hsmicroscopes.com/spine / (855)854-5810 (pg. 2)
K2M. www.k2m.com / (866)526-4171 (pg. 32)
Medtronic. www.medtronic.com / (800)633-8766 (pgs. 21-24)
National Medical Billing Services. info@nationalascbilling.com / www.
nationalascbilling.com / (866)948-7673 (pg. 5)
Pacira Pharmaceuticals, Inc. www.exparel.com / (855)793-9727 (pgs.
27-28)
Zavation. info@zavation.com / www.zavation.com / (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
