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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