Milton Hall Surgical Associates - Fraudulent billing

Posted on Monday, May 14th, 2012 at 12:46pm CDT by 37479612

Company: Milton Hall Surgical Associates

Location: 2365 Old Milton Pkwy. Ste 300
Alpharetta, GA, 30009-2140, US

Category: Other

re: Milton Hall Surgical Associates, Alpharetta, GA

Some years ago, I had (still do have) sinus issues - and had a deviated septum corrected by the above group of physicians (who operate a two-fold office in Alpharetta, GA..downstairs is plastic surgery, upstairs is sinus and allergy center with a surgical center in their basement). When I had a major upper respiratory infection over New Years 2012, I was on Amoxicillin for two weeks (from a MinuteClinic where I live in Conyers, GA) and the infection was not "moving out" so contacted this group again to evaluate whether or not there was more going on.

The entire visit on 1/20/12 consisted of sitting in their office for 2 hours, and seeing a physician for about 20 minutes wherein she informed me she thought the medication was working and to return if I had problems.

The first billing I received was in March and I called my insurance (CIGNA) to inform them there was no surgery performed as it was billed as such. They informed me I should not worry, it was a misbilling and to wait for a final bill. I received it on 5/10/12 (dated 5/4/12) that indeed I'm to pay $251.08 in excess of what CIGNA paid for "surgical" services.

Called their office, spoke to Cathy (678-347-2046) who informed me it was an invasive procedure and the AMA allowed them to bill it as "surgical" (which is a fallacy since the AMA has NOTHING TO DO W/BILLING- I'VE CALLED THEM)and the gist of the matter is that the physician shone a laser pointer up my nose to see my sinuses which is what they're calling "invasive"when surgery (from my medical training) is cut/suture/anesthesia which DID NOT HAPPEN!

I have contacted the Joint Commission on Accreditation and they have no jurisdiction over this issue since this particular group is not accredited in the State of Georgia (how, I'm not sure)but knowing this, makes me wonder about the entire practice and whether it is safe to EVER go there?

I already know how the State of Georgia feels concerning "balance billing" and if indeed this is what this is, then I will just pay it and move on (and never darken their door again), but I'd like to find out if there is an "allowance granted within Georgia" for mislabeling of billing in order to fatten their coffers.

Below is what the Joint Commission had to say:

May 14, 2012

Anna Warren

3411 Uncle Genes Way SE

Conyers, GA 30013

Incident #81638ASX-31761SAH

Dear Ms. Warren:

I am writing in response to the issues you communicated on 5/11/2012 to The Joint Commission regarding Milton Hall Surgical Associates.

We have reviewed our records and have determined that Milton Hall Surgical Associates is not currently accredited by The Joint Commission. As a result, we have no authority to evaluate your complaint. We have, however, retained your information for future reference.

You may wish to consider contacting the Georgia Department of Health, as they are in a position to evaluate your issues.

The Joint Commission stands ready to receive and review issues of concern about accredited organizations at any time and will act in accordance with all the information that is provided to us.

Sincerely,

Office of Quality Monitoring


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