Whistleblower accuses Adventist Health of overbilling millions

A whistleblower lawsuit accuses seven Adventist Health System hospitals in Florida of overbilling the government for tens of millions of dollars for more than 10 years, the Orlando Sentinel reported.

According to complaint filed in July 2010, the hospitals improperly used billing code modifiers and electronic bill presentation to overbill Medicare, Medicaid and Tricare for services provided, according to the order. A bill-coding and reimbursement compliance officer said she routinely witnessed code "modifiers" misused in ways that would result in extra reimbursements.

U.S. District Judge John Antoon last week denied the Florida-based system's motion to dismiss, as the suit met the requirements of "describing the alleged fraudulent acts, why they were fraudulent, when they occurred and who engaged in them," he said in the order.

The health system could be on the hook for reimbursing the millions of overpayments collected, as well as doling out civil penalties of $5,500 to $11,000 per false claim, the Sentinel noted.

"When you're looking at something that happened thousands of times and that carries substantial civil monetary penalties for each claim and treble damages, the total exposure could exceed $100 million," the plaintiffs' attorney, Marlan Wilbanks, told the newspaper.

The accused hospitals include Florida Hospital Orlando, Florida Hospital Altamonte, Florida Hospital Apopka, Florida Hospital East Orlando, Florida Hospital Celebration Health, Florida Hospital Kissimmee and Winter Park Memorial Hospital.

The whistleblower suit will go trial December 2013.

It seems Adventist Health is no stranger to alleged billing issues. Earlier this year, four of its Florida hospitals paid a total of $3.9 million to settle allegations they submitted false claims to Medicare. They were among 14 hospitals across the country that shelled out a combined $12 million.

To learn more:
- read the Orlando Sentinel article
- here's the judicial order