Has anyone found fraudulent charges on a hosp. bill?

[luvwinnie]

My father requested an itemized copy of my mom's hospital bill (she passed away 4:48 a.m. on July 12). My mom had Medicare and another insurance so my dad isn't responsible for the bill, but we found major problems with it. First of all they charged $2600 for something she did NOT have done. Then there is an extensive list of medications for July 12...and doses much higher than she ever took. She passed away at 4:48...there is no way these meds were given between midnight and then...it was way too much medication...we are going get a copy of her chart tomorrow and read over that before calling Medicare to tell them to investigate.

The other problem is that I do not see blood tests on here that we were told they DID run...very important tests. Definitely want to see her chart to see the results if they did indeed run them.

 

[Dan Murphy]

Certainly have seen errors, not what I would think was fraud though. A phone call always straightened things out.

 

[luvwinnie]

You are right , Dan...I'm tossing the word fraud around too easily, but these things really get to me because how often do Medicare and other ins. policies pay fpr things that weren't done? And this is why so many Americans can't afford health insurance.

 

[phillybeth]

Yes, my DH was in the emergency room for a dog bite, was never admitted, but the bill had him recieving Respiratory Therapy! We were told it is 'hospital practice' that if you are there more than 4 hours it is automatically added! Needless to say we fought it and it was removed. This is why medical and insurance bills are so high. I always go over my itemizations when they come in.

 

[Disney Doll]

As far as the medications, I can tell you that at my hospital we have what is called "unit dosing". What that means is that if a medication is supplied in a "unit" of 100 mg., even if the patient only gets 50 mg. they are charged for the whole unit. For example, IV Lasix is a frequently-ordered medication on my floor. It is a diuretic. It comes in a 100 mg. vial, but often a 40mg or 60 mg. dose is ordered. You take 40 or 60 mg. out of the 100mg. vial, but the rest of the Lasix in that vial is wasted. So even though the patient didn't necessarily receive the 100 mg., the 100 mg. vial is what is charged, because once any portion of it is used, the rest is a waste.

I would urge you to get a copy of the medical record and have someone who is familiar with deciphering medical records review it. You may have in fact found fraud, but you may have also human error in terms of a data entry person hitting the wrong key on a computer or something.

But by all means follow-up. It will be interesting to say the least.

My condolences on the loss of your mother.

 

[CarolA]

What probably happened is that someone entered the wrong charges. It happens. While the goverment would like to call it Fraud, it is more likely to be human error.

Call the hospital and ask for an audit of the bill. They will do it and fix the charges. (THey want the charges on the right bill also!) Unless you are a medical professional you are going to have a very hard time matching everything to the bill. For example, the doc may refer to the drug by it's "Brand" name like Tylenol, but you get the generic. Also, doctors have the WORST handwriting known to man... your hosptial staff is used to reading it and can call the doctors for clairification.

Also, Medicare pays based on the diagnosis code. So its not like the hosptial is charging extra stuff just for payments. Unless your Mom was a VERY high dollar case they didn't get paid for anything, just a flat rate based on her diagnosis. (Which trust me comes is NOT near enough to cover the actual cost of her stay. That is why the rest of us get charged so much!) CMS (medicare) does not agressively pursue these cases unless they get a LOT of complaints or someone within the hospital blows the whistle. (I used to work for a heathcare company and people "Truned" us in constantly. However, the goverment investigation that did take place was not triggered by the complaints but by an employee taking a BUNCH of data to CMS. And yes the goverment claimed it was fraud and we paid, but since I got to know the employees involved I am pretty sure that the real cause was STUPIDITY!)

Getting the chart may be fun! The Goverment has outlined rules for allowing people other then the patient to see the chart and off the top of my head I can't recall what the rule is in a case like yours.

 

[FroggyinArk]

after my accidsent i was taken by local ambulance to local er then on to jackson miss,,, i was charged fore three back boards and 2 neck braces, but according to emt i never left the one back board they started out with at scene, once we started getting bills from ummc in jackson we found a 3000 dollar or charge for 9/23/03 and i wasnt injured till 10/2, am trying now to get al;l my records together but htey want to charge us a 250 dollar copty charge after telling me on phone there was no charge for it.

 

[birdiesunshine]

As a matter of fact, when we saw our bill from my labor and delivery stay they charged us for a circumsision. I had a GIRL!!!

 

[luvwinnie]

lol birdiesunshine!!

 

[Deb & Bill]

Just got a bill for $1000 (less the insurance payment, so it came to about $270 for me) for surgery. My son broke his arm. So I called the insurance company about this. They told me that's how they code the casting procedure in the office. So it was okay, but I wanted to check it out to make sure.

Coding errors are made from time to time.

 

[Jeafl]

When I had foot surgery, the bill said that there was a second doctor there that we needed to pay. I know for a fact that she was never there. The reason I know this is that I was good friends with her husband, so I knew them socially. I knew for a fact that they were on vacation when I had my surgery so she couldn't have been there. I tried to tell my insurance company that she wasn't there, but they pretty much just shrugged it off and said we'll just pay her. If she sent a bill, she must have been there. Now you know why the cost of healthcare is skyrocketing.

 

[Junebugwv]

Sometimes there are real mistakes made. We received an itemized statement for charges to our insurance company for "my" gall bladder surgery. I can't tell you how many times I looked over that statement while thinking, "I've never had my gall bladder removed." But there was my name, at our hospital (my DH is a Dr there). I looked at the date and realized it was a Sunday morning. I teach a class at church and I know my gall bladder-intact body was at church that morning.

It took some calls but we finally found the answer. A woman with my same name was traveling through the area and came to the ER with serious symptoms for gall bladder disease. She had surgery and went on her way a few days later. The billing clerk at our hospital recognized my name, pulled up my records and my insurance was billed. My insurance paid, too. Believe me, my insurance company was more than happy to hear from us and said they would handle all the details.

As far as fraud is concerned, that hurts all of us!

 

[kwdietrich1]

4 years ago when I was very sick with kidney failure, I had to visit the hospital very often. Hospitals are very quick to say oops we just coded it wrong. Well after receiving a bill for a chest x-ray from the hospital (before it was billed to my insurance co) I called to ask why I received a bill for a procedure I had never had at that hospital. The cust rep said I most certainly did have that procedure. I told her for that day I was not admitted to the hosp nor had I left my cubicle from emergency room (I had an appt with my doc there on a sat since he obviously didn't have office weekend hours). She stated that my doc ordered the test. I told her that he may have ordered it but I certainly did NOT have it! I was conscious the whole time! Well she told me she would have to look into it. Mean while my insurance co paid the bill. Well a few weeks later I get a call from the hospital saying that I indeed did have the xray and that even the insurance co paid it, so I must have had it! I decided that I was getting nowhere with this woman and decided to call my insurance co. When I did they thanked me and handled it from there. I was never really sure if the insurance co got there money back, but since then I always check my records and itemized bills very carefully. And that hospital still charges my insurance co for procedures that were never done. I call my insurance co each time. You would think that this Hospital would get into major trouble!? I once received a bill for blood test that I never had. I know this because it was dated for March 98 and I had not even visited a hospital until April of 99. It could be human error, but really feel that hospitals try to get away as much incorrect billing as possible.

 

[CarolA]

The reasons hosptials don't get into "major trouble" is becasue periodically the insurance company sends someone out to audit the bills and settle up. In a lot of these cases the net gain is small. Lots of hosptials undercharge as much or more then they overcharge.

While you hear about overcharges you NEVER have someone call a hospital and say "I had a chest xray where's the bill?".

 

[mermaidlady]

I have had incorrect bills. DS cracked his head at school and was taken by ambulence to the hospital. The EMT's tried twice to start an IV and were unable to. on the bill were IV supplies which I can see but also daily maintenence and pump charges. That came to almost $200. To make matters worse the ambulence charged for the same supplies (it was a city ambulence not private). I called the hospital and they said they would look into it. 1 1/2 months later I got a bill with the exact same charges called back and the billing dept said they ER hadn't got back to them. Fought that and finally and the bill straightened out but not before I got the ins co involved

 

[Lewski709]

Yes and if I find it and report it to my insurance co and get the billing party to correct it, I get 10% of the money found to be erroneous. In this case, that's almost and AP for WDW. Check with the insurance company to see if they have this kind of policy.

 

[nuts4sn00py]

My son had surgery when he was 9mos. old & when we got the bill from the hospital my DH almost passed out. When I looked at I noticed I was billed for days my son wasn't even in the hospital. I called both the insurance company & the hospital & had it corrected. Than many years later I had a Dr. from the same hospital try to garnish my paycheck for monies he said he was never paid for that same hosptial stay. I had no idea who this Dr. was & had to go to court to stop the garnishment. The amazing thing is I found out he was the head of one of the Pediatric Depts. at the hospital & was forced to resign when they found he was stealing drugs from them. I guess he needed some money & thought he would come after me. WRONG! I fought it & won, but I will never get over the embarrasement of almost having my paycheck garnished from this unscrupulous Dr. Kathy

 

[CDoobee]

I spent some time in the hospital after having my wisdom teeth removed. On the bill was a charge for sanitary pads!! I don't know if that's what they really used or not, but if so, no wonder I was gagging on the packing when I woke up in the recovery room!!

Debbie

 

[mom2grace]

Originally posted by CarolA
The reasons hosptials don't get into "major trouble" is becasue periodically the insurance company sends someone out to audit the bills and settle up. In a lot of these cases the net gain is small. Lots of hosptials undercharge as much or more then they overcharge.

While you hear about overcharges you NEVER have someone call a hospital and say "I had a chest xray where's the bill?".

I visited a dermatologist several years ago and never got a bill. I called the office TWICE to tell them. I never did get a bill, but I tried!

 

[dbogen]

When my DS11 was born I requested an itemized bill. They charged me for 2 circumcisims. I call the billing dept and said I only had one boy with one *****(can I type that), she laughed and removed the second charge from the bill. The same DS just broke his leg and we spent 3 days in the hospital I am waiting for the itemized list to see what is charged.

Deanna