How Is This Medical Bill Possible?

Two recent hospital admissions and the medical record dictation records events, visits, and documentation of physical examinations that did not occur.

Hospital stay 1 was for asthmatic bronchitis.  Thru the ED I was admitted to a FP, who consulted a Pulmonary doc.  The Pulmonary did H & P and all of the treatment and exams during stay, and did a great job.

The FP spent about 2 minutes total during the stay.  He did no exam ever, yet billed Medicare for multiple visits, exams and did discharge note, including physical that was never done.

Is this the new way if generating income by false documentation and upcoding?

Hospital stay #2 was admission for removal of benign meningioma.  Early morning admission, visit with surgeon about 2 hours after surgery and no further doc visits that day.  Medical record documents extensive note from critical care team, including physical exam of me that never occurred.

Day 2 was noteworthy for increasing headache from 6 level to 7, then 8, then 9.  Complaints of severe headache and severe nasal congestion finally discovered by my own research of side effects of Kepra, started without any discussion with me.  Multiple complaints to nurses 3 times finally resulted in doc visit after he went to lunch.  Significant change in Med’s and Ct scan resulted in decrease in pain after 4 to 5 hours.  I had demanded d/c of Kepra prior to this.  At about 1 PM there is documentation in medical record of another critical care team visit with NP and MD supervisor noting another non-existent physical exam stating patient in no distress.

On contact with hospital they continue to assert that the exams did occur as documented.

Contacted IG of Medicare with no response.

Multiple letters and phone calls to hospital.

Is this new and accepted practice to compensate for low reimbursement levels?  Anything further to do or am I beating my head against the wall?


Categories: Uncategorized

3 replies »

  1. Have you read Malcolm Sparrow’s 2000 book, License to Steal How Fraud Bleeds America’s Health Care System? It’s been noted on this blog that nothing has changed since he wrote his book. Sparrow wrote “The OIG Fraud Hotline appears to treat reports of false claims as routine billing disputes, rather than reports of potential fraud.” Earlier this year, I reported receiving a robocall, apparently connected to Voice Recognition technology. It offered to enter me in a drawing for $500 if I gave them my Medicare Number. I hung up without responding. Evidently, a cheap way to collect Medicare numbers for submission of false claims. I never heard from the OIG. Get one of those protective helmets for your head.