COMMENTARY | Hospitals make mistakes every day. Some are related to patient care. In some cases, the errors are related to billing. When the mistakes are minor, patients may never know the difference. When they’re to the tune of $44 million, people suddenly start paying attention.
On Jan. 16, 2012, ABC news presented the case of the unemployed doorman who was charged around $44 million for his pneumonia treatment. PYH services, the billing firm responsible for the error, explained that many patients received bills with invoice numbers that were accidentally substituted for the amount due. Of course, when the patient opened his bill, he panicked.
Most of us would notice a mistake of such an egregious sum, but smaller discrepancies may easily go unnoticed. Though this particular man wasn’t held responsible for paying this erroneous and outrageous bill, it makes one wonder: how often are people overcharged for hospital stays without knowing it?
The FBI reports that health care fraud costs Americans $60 billion per year, and warns that “recent cases also show that medical professionals are more willing to risk patient harm in their schemes.” It offers tips on avoiding being the victim of these scams. Among them, it recommends not giving a medical provider blanket authorization to bill for services rendered. It also advises to carefully review the insurance company’s explanation of benefits.
Though the case of the $44 million dollar bill was the result of a mistake, there are scam artists out there — and some of them prey on the sick. In fact, some of them are the very ones you depend on for your healthcare.
Several recent press releases from the U.S. Attorney’s office indicate that healthcare fraud is an ongoing and widespread problem. One on Jan. 12, 2012 reveals that a home health agency near Los Angeles recently plead guilty to health care fraud amounting to over $5 million.
On Jan. 11,2012, a podiatrist from Baltimore, Maryland was sentenced to a four year prison sentence for fraudulently billing Medicare over $1.1 million. Just a few days before, on Jan. 9, a pastor was sentenced to 180 months for playing a role in a $14.2 million Medicare fraud scheme.
Health.com reports that an independent hospital bill auditor from Edward Waxman and Associates has found cases where hospitals overcharged patients by over $10,000. “There is no way to avoid being overbilled. It is going to happen,” Waxman says. “In the last several years of looking at hundreds of bills, I’ve run across only one hospital bill with no errors.” So unless we’re looking for those mistakes, and disputing them instead of just paying those overcharges, most of us have probably already overpaid our healthcare providers.
Patients need to pay close attention to the billing practices of healthcare and insurance providers. Don’t wait for a million dollar discrepancy to alert you of a problem. Watch bills carefully, and don’t hesitate to ask questions about charges. If the “medicalese” makes the bill too hard to understand, ask for a layman’s explanation.