A conversation with a senior citizen can be revealing. Medicare typically covers 80% of hospital costs, not including the first day of the stay. Medicare also carefully reviews hospital charge, and often refuses to pay certain charges it deems to be inappropriate. At that point, the hospital will attempt to collect from the patient.
A client recently reported a conversation she had with her father, who reported an incident of abusive billing by his local hospital. He had a pacemaker implant, which took less than half an hour. The pacemaker implant was done with mild sedation, and when my father received the bill from the hospital, he was billed for the services of two anesthesiologists, for 4 hours each. He called the hospital and explained that he sat in the hallway from 8 until 10:30, a period of time for which the hospital had claimed the two anesthesiologists were present. The implant itself was completed in 30 minutes, during which he discussed Coptic Christianity with the cardiologist. One anesthesiologist was required to be present because of the sedation. It is not clear why the second anesthesiologist showed up. They left at 11.
The client’s father looks at his hospital bills, especially when Medicare disallows a charge which the hospital later attempts to collect from him. He called the billing department and asked them for an explanation of the charge, which was $800 after Medicare and his secondary insurance plan had paid their portion of the bill. The hospital representative explained that he was billed for 4 hours of service by the two anesthesiologists. Medicare had disallowed the bill for one of the anesthesiologists because she had allowed her certification to lapse. Her father told the hospital representative that not only were the two doctors not present for longer than 30 minutes, but two doctors were not necessary and he did not plan to pay the bill unless he was ordered to do so by a court. The hospital quickly removed the charges.
Her mother-in-law was reviewing the many bills and notices she receives from various facilities, doctors, and statements from Medicare, when she noticed that a local equipment company had been billing Medicare on her behalf for a wheelchair, at $140.00 per month, a wheelchair she had never seen or needed. She called the owner of the medical equipment supply company and pointed this out to him, and he became quite agitated with her. No wonder, as he was engaged in Medicare fraud, and probably on a wider scale than this one instance. We have suggested she report this crime to Medicare, but she, like many elderly people, fears getting on the wrong side of what appears to her to be a monolithic healthcare system.
The United States is one of the only countries in the developing world in which people end up in bankruptcy due to medical bills. Sadly, some of those bills are due to cost transferring, and it is difficult to actually pin down hospitals for the cost of a procedure or hospital stay. This is because hospitals are involved in multiple agreements with different third-party payers, and they shuffle costs around to maintain profitability. Even non-profit hospitals are run this way, and although they are technically non-profit, administrators and high-level employees benefit from incredible perks, including board meetings in Hawaiian resorts (St. Dominic’s Hospital in Jackson, Mississippi) or satellite offices in Italy and Ireland (University of Pittsburgh Medical Centers). At the same time, patients are subjected to inadequate care due to inadequate staffing by nurses and aides.
If you receive a suspect hospital bill, or believe you have been used in a Medicare fraud scheme, you should see an attorney for an evaluation of your case. You may be able to challenge unfair charges, or charges for services not received. If you don’t challenge these charges, the hospital will turn your bill over to a collection agency and you will find yourself in a defensive posture. With respect to Medicare fraud, the government rewards whistleblowers, and your attorney can explain the law in this respect.