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 pushes 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 undoubtedly 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 billing errors

Below you'll find the most common medical billing errors and what you can do to protect yourself:

• Repeat billing: ensure you haven't been charged twice for the same procedure, supplies or medications.
• Length of stay: Double check the dates of your admission and discharge. Were you charged for the day you checked out? Most hospitals will charge for the day you arrived, but not for day you left.
• Correct charge for type of room: If you were in a shared room, confirm you're not being charged for a private one.
• Time in OR: Sometimes hospitals charge based on an "average" time needed to perform an operation. Contrast the charge you received against your anesthesiologist's records.
• Up coding: Happens when a doctor changes an order for medication and/or service from an expensive version to one that costs less, like generic medications. And yet you're billed at the higher rate. And sometimes you're billed for both. Keep on top of this one; it's the most widespread of all the common billing errors.
• Keystroke mistake: Happens to the best of us, an innocent slip up on the keyboard that can result in significant overcharges or in some cases an undercharge.
• Canceled service: Occasionally a medication, procedure or service that was prearranged and then canceled later will still show up on your final invoice.

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.

According to comments made by Bill Hahon of the National Health Care Anti-Fraud Association, "These professionals have sprung up because there are so many errors. They are saving people money, and sometimes it's a lot of money."

Medical Billing Advocates of America is one of professional companies mentioned by Mr. Hahon. Based in Salem, Va., it operates in 18 states and the District of Columbia. These companies often work on a contingency basis, indicating they get paid a percentage of the total amount they save you. However, that percentage often runs as high as half, so make sure you understand their charges before putting them to work.

You can find others firms in this line of work 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 at 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 is 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.