A federal judge has thrown out a whistleblower’s lawsuit against Epic Systems Corp., the massive health care technology company based in Verona, declaring that the allegations of fraud were “pure speculation.”
A former employee at a health care system in North Carolina filed the complaint in 2015, claiming that Epic’s software featured settings that could let clinics and hospitals double-bill the government for Medicaid and Medicare-covered services. The employee, Geraldine Petrowski, filed her complaint secretly under the False Claims Act, a law that lets the U.S. Department of Justice investigate allegations of government fraud.
After reviewing Petrowski’s allegations, the Department of Justice declined to take up the case. Petrowski elected to pursue the case on her own, but on Tuesday, U.S. Judge James Moody struck the complaint down.
Moody, a federal district judge in Florida, wrote in an order that Petrowski’s case against Epic was “woefully deficient.” The case merely described the possibility of fraud, he wrote, and featured no evidence that any fraud actually occurred.
“Broken down, her allegations amount to no more than an assertion that the Epic software theoretically could have been used to lead to incorrect billing,” Moody wrote in his order.
Petrowski previously worked as a liaison to Epic in her role at a health system called WakeMed. According to her complaint, she raised concerns about software settings she encountered that she alleged lets health care providers itemize anesthesia services in a way that charges for the same procedure twice.
According to Petrowkis’s complaint: “This unlawful billing protocol has resulted in the presentation of hundreds of millions of dollars in fraudulent bills for anesthesia services being submitted to Medicare and Medicaid as false claims.”
However, Petrowski did not provide evidence to support that allegation. To support her case, Petrowski submitted copies of Epic training materials on anesthesia billing that featured language she believed encouraged double-billing. She also submitted a medical document that itemized a medical procedure at a cancer center in Texas. Petrowski claimed that the document was a bill that proved that at least one other provider had double-billed for anesthesia through Epic’s software.
Epic, in its motion to dismiss the lawsuit, suggested that Petrowski fundamentally misunderstood the documents she submitted.
“(The medical document) does not show what (Petrowski) alleges and, in fact, is not even an anesthesia bill or claim for payment,” wrote Epic’s attorneys.
In his order, Moody agreed that the exhibits “do not support the allegations of purported double-billling.”
Meghan Roh, Epic’s primary public affairs officer, wrote in an email that the company was pleased with the outcome.
“As we previously stated, the plaintiff’s assertions represented a fundamental misunderstanding of how claims software works,” wrote Roh.
According to the trade publication FierceHealthcare, Petrowski’s attorneys have indicated they might appeal the decision.
The judge’s order comes as the Supreme Court considers a labor lawsuit against Epic Systems. Attorneys made oral arguments in that case, which has to do with the legality of certain arbitration contracts, in October.