6 latest healthcare industry lawsuits

https://www.beckershospitalreview.com/legal-regulatory-issues/6-latest-healthcare-industry-lawsuits-091018.html

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From national healthcare organizations refiling a lawsuit over 340B drug pricing program cuts to a Georgia physician accused of submitting thousands of false claims to Medicare, here are the latest healthcare industry lawsuits making headlines.  

1. CHS, Quorum say investors weren’t duped into buying stock at inflated prices
Franklin, Tenn.-based Community Health Systems and Brentwood, Tenn.-based Quorum Health urged a federal judge not to grant class certification in a shareholder lawsuit alleging Quorum’s stock was trading at an inflated price after its spinoff from CHS.

2. Georgia physician allegedly submitted 4,500 false claims for unnecessary lead poisoning treatments
Federal investigators allege Charles Adams, MD, a physician in Fort Oglethorpe, Ga., injected thousands of patients with a lead poisoning treatment they didn’t need, and billed the government $1.5 million for medically unnecessary treatments.

3. Premera Blue Cross accused of destroying evidence in data breach case
The plaintiffs in a class-action lawsuit against Premera Blue Cross, which involves a 2014 data security incident, claim the payer “willfully” destroyed evidence that would have provided details of the breach.

4. Hospitals refile lawsuit against CMS over $1.6B in 340B cuts
The American Hospital Association, along with several other national healthcare organizations and hospitals, refiled their lawsuit against HHS to reverse Medicare payment cuts for drugs purchased through CMS’ 340B drug pricing program, the AHA announced Sept. 5.

5. Medical center owners allegedly double billed insurers, altered patient records as part of $80M scheme
Four people were charged in an $80 million Medicare fraud scheme that involved providing unnecessary medical treatment to patients.

6. Physician imposter allegedly diagnosed patient at California hospital
A 23-year-old man is accused of impersonating a physician at California hospitals.

 

 

Lawsuit: Epic’s software double-bills Medicare, Medicaid for anesthesia services

https://www.beckershospitalreview.com/finance/lawsuit-epic-s-software-double-bills-medicare-medicaid-for-anesthesia.html

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Health IT giant Verona, Wis.-based Epic Systems has been hit with a False Claims Act lawsuit that alleges the company’s software double-bills Medicare and Medicaid for anesthesia services, resulting in the government being overbilled by hundreds of millions of dollars.

The lawsuit, which was filed under the qui tam provision of the False Claims Act in 2015 and made public Thursday, alleges Epic’s billing software’s default protocol is to charge for both the applicable base units for anesthesia provided on a procedure and the actual time taken for the procedure. This results in the provider being reimbursed twice for the base unit component, according to the lawsuit.

The whistle-blower who filed the lawsuit, Geraldine Petrowski, worked at Raleigh, N.C.-based WakeMed Health from September 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 software at WakeMed Health.

Ms. Petrowski claims she provided examples to Epic representatives illustrating the double-billing practice, and the company initially ignored her complaints. “It was only after relator, Petrowski, reiterated her direction to fix this software 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 fraudulent bills for anesthesia services being submitted to Medicare and Medicaid as false claims.”

In a statement to Healthcare IT News, an Epic spokeswoman said, “The plaintiff’s assertions represent a fundamental misunderstanding of how claims software works.”

The Department of Justice declined to intervene in the case, and the whistle-blower will move forward in the case without the government.