Fraudulent hospital charges III: Imposter billing

This is the third of Elisabeth Rosenthal’s complaints about hospital charges following her husband’s motorcycle accident (see previous posts for the first two). “Imposter billing” refers to bills from doctors her husband never met. Some of these bills were understandable, such as services rendered by the radiologist who read his scans. But some bills were for “bedside treatment from people who never came anywhere near the bed to deliver the care.”

One such “imposter” is the resident-in-training who put a few stitches in her husband’s finger. But the $1,512 bill for this treatment came in the name of a senior surgeon as if he’d done the work. The resident who put in the stitches is considered an “extender”—a stand-in with less training who works under the supervising doctor. Extenders include residents, physician assistants, and nurse anesthetists. For billing purposes, this allows the senior provider to be in many places at once. He or she need not even be in the vicinity.

The number of extenders has increased 11 percent since 2008. Supposedly this is because of a shortage of physicians, but a greater factor is cost reduction. As one analyst put it, “the cost-per-hour difference in who is handling a given task can be substantial.” Using extenders is a way, he says, to “enhance revenue for the organization”—the organization being the hospital, of course. So the hospital is saving money, but the patient is being billed at the non-extender, senior physician rate. It would be OK with me for an underling to stitch me up, but don't pretend that the work was done by an M.D.

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Fraudulent hospital charges II: Cover charge

This post is a continuation of last week’s, which was the first in a list of complaints by Elisabeth Rosenthal—physician and journalist—about hospital billing practices following her husband’s bicycle accident.

What Rosenthal calls a "cover charge" is actually a “trauma activation fee” that was billed at $7,143.99. Rosenthal wondered what this was for, since every component of her husband’s care was billed separately. For example, a single CT scan, which covered his head, upper spine, and maxillofacial bones, was billed three times. The trauma activation fee was a separate charge.

The trauma activation fee came into practice following 9/11 when the Trauma Center Association of America, an industry group, convinced regulators that they needed to be compensated for maintaining a state of readiness. “Wait,” Rosenthal says, “isn’t the purpose of an E.R. to be ‘ready?’ Isn’t that why the doctors’ services and scans are billed at higher rates when they are performed in an emergency department?”

This is all new to me. In my own research, I learned that there’s a huge variation in trauma activation fees—such as $1,112 in one hospital and $50,659 in another. Supposedly, the purpose of the fee is to avoid missing a seriously injured patient by engaging a team to examine him or her. But those medical professionals are already in the hospitals and are being paid. One researcher on this topic tells the story of a California hospital that charged a $22,550 activation fee for a young man injured in a minor motorcycle accident. He suffered a cut on his head that required two staples. He received some IV fluid and ibuprofen, but no x-rays, scans, or blood work.

The next time you get a bill for your visit to the ER, let me know what the hospital charged you for the “trauma activation fee.”

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Fraudulent hospital charges I: Medical swag

Elisabeth Rosenthal—former emergency room doctor and current journalist—is my favorite hospital basher. Her husband was recently in a bicycle accident and suffered broken ribs, finger, collarbone, shoulder blade and a collapsed lung. As she says, “the treatment he got via paramedics and in the emergency room and intensive care unit were great. The troubles began, as I knew they would, when the bills started arriving.” She was prepared for the outrageous costs, such as $20 for a pill that costs pennies at a pharmacy. “What I’m talking about here,” she says, “were the bills for things that simply didn’t happen, or only kind-of, sort-of happened, or were mislabeled as things they were not, or were so nebulously defined that I couldn’t figure out what we might be paying for.” Though the charges were technically legal, she calls them, fraudulent. Here is part one of her complaints.

In the trauma bay, someone slapped a plastic brace around her husband’s neck until scans confirmed that he had not suffered a spinal injury. It was removed within an hour. The company that provided the brace billed $319 for the piece of plastic. Their insurer paid $215. (On Amazon, they are about $15.)

Insurers allow companies to bill them for the stuff--what Rosenthal calls "swag"-- that you get for home use, such as slings. But the same sling you can buy at Walgreens for $15 is billed to the insurance company at $120. Apparently, the practice of handing out such medical “swag,” such as slings, braces, and wheelchairs, has led to widespread abuse, with patients sent home with equipment they don’t need. (Rosenthal and her husband didn’t take the brace home, even though they’d paid for it.)

In my own case, after a visit to the emergency as the result of a fall (the chair I was standing on tipped over; I hit the ground on my hip and elbow) I was sent home with a cane, even though I was basically fine (nothing broken). I have no idea what the insurance company paid for it. I kind of like having the cane, though. By holding the tip end, I can reach the levers that open and close the windows over the washing machine and use the handle to grab the levers and raise them up or down. Also, because it’s adjustable, I can make it short and use it to lift myself up from the low stool I sit on when weeding. I’m not sure I could think of anything to do with a neck brace.

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The genetic aspects of sleep patterns

I’ve always thought the notion that everyone needs eight hours of sleep a night was a crock. This sort of admonition just worries people and drives them toward medications. “Experts” say that sleeping less than seven hours per night on a regular basis is associated with adverse outcomes, such as diabetes, heart disease, hypertension, and a lot more. I don’t buy that, either. As it turns out, now scientists are saying some people do well on less sleep. Duh.

Researchers have now found people who are natural “short sleepers.” They average only 6.25 hours of sleep a night and suffer no ill effects. This group is healthy, optimistic, and has a high pain threshold. Being a short sleeper, they’ve found, is a genetic thing—a mutation, they call it—which has been shown to facilitate learning and memory, reduce anxiety and block the detection of pain. And what about the three the hunter-gatherer societies whose sleep patterns were studied? Researchers found that those folks average 6.5 hours of sleep per night (as I reported in an earlier post). As for me, I usually sleep between six and seven hours—rarely eight. At any rate, I don’t worry about not getting enough sleep. I figure my body will get the sleep it needs.

Scientists know the biological processes that tell our bodies when to sleep—our circadian system. But they don’t understand the system that tells our bodies how much sleep we need. Not only that, they have never figured out why we need to sleep at all. As one scientist said, “when it comes to what sleep is, how much you need and what it’s for, we know almost nothing.” So don’t go telling me how much sleep I need.

For an introduction to this blog, see I Just Say No; for a list of blog topics, click the Topics tab.