Adventist Health Emergency Rooms Overbilled Medicare, Suit Says

Adventist Health System/Sunbelt Inc. was accused in a lawsuit filed by whistle-blowers of routinely overbilling Medicare for emergency room services at eight central Florida hospitals the company owns.

A complaint originally filed in 2010 in federal court in Orlando, Florida, was expanded this month to include claims that the emergency room overbilling of the government health insurance program for the elderly and disabled was known to upper management at the hospital chain and took place from at least 2001 to 2008.

Adventist Health, a nonprofit based in Winter Park, Florida, “has submitted improper claims for payment and has intentionally failed to refund the payments received,” according to the amended complaint.

The media office at the hospital chain didn’t immediately respond to an e-mailed request yesterday for comment on the lawsuit.

The original complaint includes allegations that the Adventist Health hospitals overbilled Medicare, Medicaid and Tricare for radiology services and a prescription medication. The company lost a bid to dismiss those claims in July.

The complaint describes several practices, including billing for computer-assisted detection services to help read mammograms, even when the CAD system wasn’t working for three months, and routinely billing for a $3,100 dose of a drug when a $700 dose had actually been administered.

Internal Audit

Florida Hospital Orlando, one of the eight facilities named in the lawsuit, found in a 2008 internal audit that in a single year, the hospital had overbilled the government and insurance companies $2 million for the drug, Octreotide.

The lawsuit was brought under the U.S. False Claims Act, which permits whistle-blowers to sue on behalf of the government and to share in any recovery.

The two whistle-blowers who filed the complaint are Charlotte Elenberger, a radiologist who worked for a hospital contractor and had staff privileges at one of the Adventist Health facilities, and Amanda Dittmann, a medical coding specialist who worked for one of the hospitals.

Adventist Health agreed to pay $3.9 million in February to settle a claim filed by the Justice Department that four of its hospitals in Florida overbilled Medicare for the cost of kyphoplasty procedures, which treat spinal fractures due to osteoporosis. The Justice Department said then that in total, more than 40 hospitals had paid at least $39 million to settle such overbilling claims.

The case is U.S. v. Adventist Health System/Sunbelt Inc., 6:10-cv-01062, U.S. District Court, Middle District of Florida (Orlando).

To contact the reporter on this story: Susannah Nesmith in Fort Lauderdale, Florida, at susannahnesmith@yahoo.com

To contact the editor responsible for this story: Michael Hytha at mhytha@bloomberg.net

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