Adventist Health, based in Altamonte Springs, Florida, has been named in a lawsuit filed under the qui tam provisions of the False Claims Act. The whistleblowers allege that several Adventist hospitals engaged in rampant overbilling of federal healthcare programs for more than a decade. The specific hospitals identified in the suit are 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 qui tam action was filed in July 2010 by two individuals who were employed by or affiliated with Florida Hospital Orlando, Armanda Dittman and Dr. Charlotte Elenberger. Dittman, a bill-coding and reimbursement compliance officer, was employed by Florida Radiology Associates from 1996 to 2001 and then by Florida Hospital Orlando from 2001 to 2008. Dr. Elenberger, a radiologist employed by Florida Radiology Associates from 1995 to 2008, had staff privileges at Florida Hospital Orlando.
The whistleblowers allege that the Adventist Hospitals submitted tens of millions of dollars in false or inflated claims to Medicare, Medicaid and Tricare, the medical benefit plan for the U.S. military, retirees, their dependents and reserve components. The complaint alleges that the whistleblowers witnessed the routine misuse of billing-code “modifiers” resulting in extra payments, the use of billing codes for larger doses of drugs than were actually administered, and billing for computer-aided-detection analysis that was not performed, among other things.
Last week, U.S. District Judge John Antoon denied Adventist’s request to dismiss the suit for insufficient evidence. The Judge ruled that the qui tam complaint satisfies the pleading requirements because it describes the fraudulent acts and identifies the “who”, “when”, and “why” as required by the False Claims Act. The case is set for trial in December 2013.
If you have any firsthand knowledge, information, or evidence related to any federal, state, county or city government fraud, you should speak with an experienced qui tam lawyer who can help you understand your legal rights and help you obtain the compensation you deserve.
If you have a claim, contact the Florida whistleblower attorneys at McCabe Rabin, P.A. for a free and confidential consultation by calling toll free at 877.915.4040 or e-mail firstname.lastname@example.org.