We have reported previously about the enormous drain that health care fraud places on tax dollars and the adverse impact fraud may have on healthcare costs. Whistleblowers are a vital resource in discovering fraud in government contracts. The False Claims Act allows individuals to file a lawsuit in federal court to help recover taxpayer money. For their involvement, whistleblowers are entitled to a percentage of any money recovered through settlement or verdict in court. Whistleblowers often work in mid-level jobs and notice some kind of anomaly that may involve fraud.
Software Program Allows Providers To Double Bill
In 2015, a former liaison between a health care facility in North Carolina and the Wisconsin-based health care records company, Epic Systems, noted that a medical billing program offered by Epic allows hospitals to essentially double-bill Medicare and Medicaid for anesthesia, according to The Cap Times in Madison. A recent news report does not specifically identify how much money may be involved. However, the lawsuit estimates that the software program may involve hundreds of millions of taxpayer dollars.
Typically, billing practices for anesthesia allow health care providers to choose between charging based upon “units” or the actual number of minutes a patient is under anesthesia. Units are defined as 15-minute periods. The lawsuit says that the software program allows health care providers to use both methods for the same service, resulting in a doubling of the reimbursements from Medicare and Medicaid.
Epic denies the claims. The Department of Justice reportedly has not joined in the lawsuit. DOJ involvement is not required under the False Claims Act.