Fraudulent hospital charges IV: The drive-by

This is the fourth of Elisabeth Rosenthal’s complaints about hospital charges following her husband’s motorcycle accident (see previous posts for the first three). Before Rosenthal’s husband left the hospital, a physical therapist came by and asked a few questions. On his report, the therapist noted “ambulation deficits, balance deficits, endurance deficits, pain-limiting function, transfer deficits”—boxes he’d checked. The report also stated that he was there for 30 minutes (it was just 10), and that he’d walked her husband up 10 steps with a stabilizing belt. He had not. In fact, he’d given no significant health service. All he’d done was check some boxes. The bill for this ten-minute “drive-by” visit, was $646.15.

Rosenthal also notes that the drive-bys continued at their home. The day after he was discharged a physical therapist from a private company called her husband’s cell phone and wanted to visit him for at-home therapy. The therapist came (not knowing which body part had been injured) and concluded he was in too much pain to participate. This occurred two more times—with her husband not receiving therapy. Nevertheless, the insurer paid for three visits.

Rosenthal asks, “why do insurers pay for all of these questionable charges?” It’s partly because they have no way to know whether you got a particular item or service. But it’s also not worth their time to investigate the millions of medical interactions they write checks for each day. As one benefits manager told Rosenthal, “they’re too big to care about you.” Moreover, electronic records, which have auto-fill billing boxes, have probably made things worse. For example, the birth of a baby boy may automatically prompt a bill for a circumcision.

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