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Lee County hires firm to investigate alleged overbilling

By Staff | Apr 8, 2009

Lee Memorial Health System claims that it has been overcharged for ambulance and ancillary services provided by the county’s public safety department, according to a complaint being investigated by Ernst and Young.
The health system approached the county over “alleged improprieties” with billing services provided by Advanced Data Processing Inc.
Lee Memorial Health System claims that ADPI overbilled for services already covered by Medicare, Medicaid or other private insurance carriers. It also claims that in some cases, services were not billed to Medicare or Medicaid as they should have been before the health system received a bill.
The Lee County Board of County Commissioners voted unanimously Tuesday to hire Ernst & Young to study 18,000 claims between the county and health system from 2004-09.
In a letter to the commission, Ernst and Young included the hourly rate of staff members to conduct the investigations ranging from $140-$595 an hour.
David Kainrad, deputy director of administrative services for public safety, said the overbilling issue centers around claims from the past involving non-emergency services or when ambulances were used to transport patients to different hospital campuses in the system.
In some instances, the insurance company and the health system were charged for the same service, he said.
“We have the (billing) process built in now, but going back a few years ago there is a question of whether the hospital should be billed or insurance billed,” said Kainrad.
Ernst and Young said in the letter that their staff would begin reviewing billing guidelines, interview officials from the health system and ADPI to understand the process, and troubleshoot any anomalies in billing data.
Officials from Lee Memorial Health System could not be reached for comment Tuesday.