A Florida judge has denied hospital operator Adventist Health System’s motion to dismiss a 2010 whistle-blower case filed against it by a radiologist and a billing coding and reimbursement compliance officer. The suit alleges that Adventist Health routinely billed government payors for computer aided detection that was never performed and for a larger dose of the contrast agent octreotide than was given.
Adventist Health System, based in Altamonte Springs, supports 43 campuses, including seven campuses of its flagship Florida Hospital, where radiologist Charlotte Elenberger, M.D., had staff privileges between 1995 and 2008. In the qui tam suit, she alleges that, in 2006, while working for Florida Radiology Associates, she saw that the hospital was billing and being paid for CAD analysis of mammography scans even though no CAD was performed for three months because the system wasn’t working.
In addition, Amanda Dittman, who handled billing for Florida Radiology Associates and later for all the radiology departments at the seven Florida Hospital campuses named in the suit, says she saw code modifiers misused in ways that would lead to extra payments and that the hospital routinely used the billing code for 5,000 micrograms of octreotide in cases where the code for 1,000 micrograms should have been used.
U.S. District Judge John Antoon called the evidence against Adventist Health System “extensive and sufficient” when he denied its motion to dismiss the case last week. (Click here for PDF of his judgement.)
Dittman and Elenberger are being represented by Marian Wilbanks, a partner in Wilbanks and Bridges, LLP, a law firm that specializes in large-stakes qui tam suits. Wilbanks told the Orlando Sentinel that if found guilty of filing false claims, Adventist Health System could be on the hook for more than $100 million.
The Orlando Sentinel reports that Elenberger is still practicing as a radiologist in Central Florida, although she no longer works at Florida Hospital campuses. Dittman has relocated and now works in California.