Former Staff File Lawsuits against Adventist Hospitals in Florida Alleging Billing Fraud
by AT News Team
Former employees of several hospitals in Florida owned by the Adventist Health System have filed lawsuits under the “whistleblower” law, according to stories in the Orlando Sentinel. Marian Wilbanks, an attorney specializing in this kind of lawsuit represents these individuals and told the newspaper that they involve “tens of millions of dollars” in overbilling Medicare, Medicaid and Tricare, Federal health benefits programs.
These are not criminal cases filed by Federal prosecutors but civil suits filed under provisions in the law that allow employees or others who observe excess billing to be paid a part of the financial settlement in cases where the court decides that the allegations are true. The first lawsuit was filed in July 2010 and additional complaints were added in October this year.
The lawsuits make four accusations: (1) Improper coding was used in invoices for radiology services to the three Federal programs from 1995 to 2009. (2) Invoices were sent for larger doses of the drug octreotide, used to enhance MRI scans, than were actually administered. (3) Invoices were sent for computer-aided analysis that was never done. (4) Invoices for emergency services were routinely submitted that were “false, duplicate or padded” from 2001 to 2008.
The newspaper has identified two individuals as filing litigation. Amanda Dittman worked as a compliance specialist in Florida Hospital’s billing department from 2001 to 2008 and from 1996 to 2001 for Florida Radiology Associates. Dr. Charlotte Elenberger is a radiologist affiliated with Florida Radiology Associates since 1995.
“I saw upcoding happening daily in heavy volumes across seven hospitals,” Dittman told the Orlando Sentinel. She reported the problems to her superiors, she said. The health system “conducted an internal investigation that confirmed double- and overbilling were occurring, the suit alleges, but did not correct the problem or refund the money,” the newspaper stated.
The health system has twice filed motions with the court to dismiss the litigation. “The first motion … was denied by U.S. District Judge John Antoon, who called the evidence ‘extensive and sufficient,’” the newspaper reported. The second motion to dismiss has not been ruled on.
“Florida Hospital takes seriously our obligations under the law,” said Samantha O’Lenick for the health system. “If we discover mistakes, we take appropriate action to correct them. … However, we believe the recent allegations … are asserted to achieve settlement pressure in … ongoing litigation [and] are without merit.” Neither Dittman nor Elenberger had anything to do with emergency department billing, O’Lenick told the Sentinel.
Adventist Today has been told by an attorney familiar with health care litigation that legal action related to billing is used by the Federal government to reduce the cost of health care and pressure hospitals into returning sums of money. It is usually not a criminal matter and the facts involved in these cases are very complex.
Florida seems to be a center for insurance billing fraud. Late this year a group of physicians and providers in south Florida were indicted and convicted of several million dollars of ovebilling and outright fraud for procedures and medical items.
If the fraud in Medicare could be curtailed, it means a large reduction in medical costs now being incurred and with the changes and new additions coming with the ACHA, it is absolutely essential that these cases be vigorously pursued. We all pay for fraud.
Aha, the worm in the apple has been revealed. This shouldn't be a revelation to anyone having medical services performed in the past 40 years. Every hosp. med. bill we ever received when covered by private insurance, we were able to reduce by an average of 30%, when we questioned the charges. (this included one, w surgery & recup. at a SDA associated facility. With many of us now in HMO's, we never see the item by item charges.
i submit this is all a farce, that the Govt. always knew what was going on. Every one was in on the payout. The AMA, pharma, research, insurance co's, MD's,were enriching the whole system with the $billions annually with their lobbyists & exorbitant insurance fees. Not saying every MD was involved directly, but were, thru their associations membership. No doubt the majority with private practice were involved as they utilized software systems which detailed what the new norms were. Some probably assumed this was known by Govt, which ignored the felonious practice.It permitted them to improve their services by upgrading to the latest equipment & systems.
In as much as the whole medical system has utilized this corrupt practice, every one involved has benefitted greatly, the politicos, the associations, insurance co's, hospitals, pharma co's, mfg'ers, MD's. A few may be offered up as scapegoats, but it will be just the tip of the iceberg. Canada instituted a compulsory Federal medical program 40 years ago. It appears to be working well for most. i have children there. The only complaint i've heard is sometimes a wait for some surgery needs. Don't know if there are less or curtailed services for the aged. i personally know 3 MD's who had good practice's in Canada, who left for the US when the Canada-wide Federal program was enacted.
i have no doubt the new Health care plan in the US will still have similar loop holes which will permit
coruption & payouts to continue, with the same beneficiaries ripping off the ever loving taxpayer.