Whistleblower Saw Imaging Billing Fraud at 7 Florida Hospitals

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The scope of a 2010 whistleblower suit filed against Adventist Health System of Winter Park, Fla, broadened this week to allege that emergency departments at seven of its affiliates bilked Medicare out of millions of dollars in imaging services.

According to a report in the Orlando Sentinel, the health system may have overbilled federal government payers Medicare, Medicaid and Tricare for as long as seven years. The complaint lists: 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.

Adventist allegedly padded claims for imaging services, submitted false, duplicate, and improperly coded claims, and billed for larger-than-administered doses of a contrast agent. The Florida Hospital may also have begun billing for the use of a mammography system prior to its actually being operational.

In a statement issued to the Sentinel, Samantha O'Lenick, a spokesperson for Florida Hospital said the allegations were “asserted to achieve settlement pressure in the context of ongoing litigation.”

However, whistleblower Amanda Dittman, a bill-coding and reimbursement-compliance officer told the Sentinel that she saw “upcoding happening daily in heavy volumes” and that Adventist “would not refund the money unless the payer specifically asked…even though they knew how often it occurred."