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.