Hospital Billing Errors and Fraud
Simple mistakes in billing made during or after your hospital stay can cost you a bundle or even ruin you financially
 In a system as complex as our medical billing system errors are bound to be made. Sometimes they are honest human errors that
occur when someone accidently puches in the wrong code. Catching that error may be difficult to impossible but if you are stuck
with a surprisingly large bill and then your insurance company refuses to pay all of it you may find yourself in a world of hurt.
Even the simplest medical procedure can cost tens of thousands of dollars. One error could add several thousand dollars to an
already hefty bill. Even if your insurance does cover the entire bill the excess cost will be passed along to you eventually in
the form of higher insurance premiums so it's in everyone's best interest to detect and correct hospital billing errors.
Finding billing errors will be no easy task
Hospital bills can be very complicated and unless you are a medical professional yourself you will undoubtably be confused by
some of the items and services listed. Don't be intimidated by this because some of the errors will be more than obvious to even
an untrained eye. If you've gone to the hospital to have your tonsils removed and see a reference to chemo-therapy it's going to
stand out on the bill. Don't be afraid to make some phone calls to question this. You might have to pay for it yourself if your
insurance refuses to pay it. Medical-related debt ranks second among causes for personal bankruptcy in the United States, after
credit card debt. That's partly because even if you are insured you may have to pay 20% of your bill out-of-pocket. A single error
could cost you hundred or even thousands of dollars.
Some of the errors may be more difficult to identify and the item may be valid even if the amount billed for it is not. Overcharges
are one of the most common billing errors. Duplication is another common billing mistake. If you see the same charge listed more
than once you should ask the hospital why. It may be a valid charge but this error is so common you shouldn't let it go unchallenged.
The most common errors
Here are the most common areas of overcharges and errors, with tips on what to do if you find irregularities:
- Duplicate billing: Make sure you haven't been charged twice for the same service, supplies or medications.
- Number of days in hospital: Check the dates of your admission and discharge. Were you charged for the discharge day? Most hospitals will charge for admission day, but not for day of discharge.
- Incorrect room charges: If you were in a semi-private room, make sure you're not being charged for a private.
- Operating room time: It's not uncommon for hospitals to bill for more OR time than you actually used. Compare the charge with your anesthesiologist's records.
- Up coding: This common billing mistake occurs when a doctor switches a high cost medication or expensive service for a cheaper alternative then charging for the more expensive item or, in some cases, charging for both!. An example of this would be the doctor replaces a top dollar brand name medication for a generic alternative.
- Keystroke error: An everyday mistake in which someone just happens to hit the wrong keyboard key. An innocent enough mistake but one that can cost you a significant amount of money.
- Canceled work: Sometimes a procedure that was ordered and then later canceled will still wind up on your final bill.
When you receive the billing from your hospital you should look to see if you were billed for services you never received. Did
you get every service, treatment and medication for which you are being billed? Check your log carefully.
If you find errors, contact your provider's billing office and your insurer. If they are of no help and the discrepancies are
significant, you may want to turn to trained professionals who will help you analyze the bill and negotiate for you.
You can also get help from the consumer protection office of your state's attorney general.
"These professionals have sprung up because there are so many errors," says Bill Mahon of the National Health Care Anti-Fraud Association.
"They are saving people money, and sometimes it's a lot of money."
Medical Billing Advocates of America is one of them. Based in Salem, Va.,
it operates in 18 states and the District of Columbia. These firms frequently work on a contingency basis, meaning they get paid a
percentage of the amount they save you. But that percentage often runs as high as 50 percent, so make sure you understand their
charges before you put them to work.
You can find others if you do an Internet search under "hospital bill review."
Medical Billing Fraud
The federal Health Care Financing Administration, which oversees Medicare, is also taking a hard look ar hospital overbilling
because they estimate that the government loses 30 cents to every dollar from fraudulent practices in the medical community.
Hospitals, doctors and other medical professionals think part of the blame lies with the complexity of the system itself. There
are over 45,000 pages of Medicare regulations but the HCFA cites specific practices like "unbundling" services to raise consumer
costs. "Unbundling" refers to billing treatments separately which are normally billed as a single, combined charge.
Health care service contractors often complain that their staff are over-worked due to the sheer volume of claims they process.
This is debatable since HCFA provides funds to help process and monitor bundled claims. While it is the responsibility of these
health service contractors to catch mistakes the ultimate responsibility for filing correctly lies with the hospital.
Non-Profits get in on the gravy train
It is also alleged that many not-for-profit hospitals habitually overcharge uninsured and underinsured patients while maintaining
their tax exempt status in the United States. While avoiding taxation, the hospitals continue to accumulate profit by charging
patients with anything but charitable rates.
These hospitals have engaged in the practice of charging inflated and inordinate rates for medical care to uninsured patients,
while providing discounts to insured patients and those on medicare or medicaid. Also, the hospitals routinely utilize aggressive,
abusive, and oppressive collection practices to recover this inflated medical debt. These practices include lawsuits filed
against patients who are poor and indigent.
|
