ERs accused of overbilling in expanded whistleblower suit

Adventist Health System is finding itself in even more legal hot water. The whistleblower suit accusing seven of its Florida hospitals of overbilling Medicare for radiology services now includes alleged overbilling in the hospitals' emergency departments, the Orlando Sentinel reported.

In the original complaint filed in July 2010, a coding and reimbursement compliance officer said she routinely saw billing code modifiers and electronic bill presentation misused in ways that would boost reimbursements, overbilling the government for tens of millions of dollars for more than 10 years.

In the new complaint, a second whistleblower claims similar billing issues took place in the EDs between 2001 and 2008, in which the hospitals allegedly submitted false, duplicate or padded medical claims.

The first whistleblower noted that Adventist Health finance directors investigated her concerns and verified instances of double- and overbilling but failed to make any rectification or refunds, the article noted.

The health system on Wednesday filed its second motion to dismiss the lawsuit, after its first motion was denied in August, according to the judicial order.

Adventist's Florida Hospital said the complaints are "without merit" and the new ED allegations are an effort to pressure it to settle, it said in a statement to the Sentinel.

If found guilty of the charges, the Florida-based system could be on the hook for tens of millions of dollars, the article noted.

The new whistleblower complaint comes amid increased government attention, in which the U.S. Department of Health & Human Services claims electronic health records encourage doctors and hospitals to overbill Medicare and increase the likelihood of fraud.

To learn more:
- read the Sentinel article