"[Pat] was here in the ER last week and had a fracture compound of the Os calcis. Someone closed the wound with an exposed piece of bone sticking out. We took the bone out and cleaned the area up. We debrided the Achilles, put in a posterior mold up on the walker. Pat will be discharged tonight with Keflex to be taken as an outpatient and Percocet for pain. We will see her in the office next week for follow up."
It is highly unusual for a physician to put such an unambiguous statement -- indicting one of his colleagues for malpractice -- into a patient's medical records. Then again, it is highly unusual for a physician to remove the bandages from a patient's foot and find a grossly infected and inflamed heel with a piece of bone sticking out of it. Much of Pat's Achilles tendon had to be debrided, which means that the tissue was so contaminated that it had to be removed. Standard medical procedure dictates bone on the inside, skin on the outside. It took 65 minutes in the operating room for Pat's heel to be returned to that condition and put in a cast. The bill came to $8,995.00.
We advised our client not to pay the bill for Pat's second visit to the hospital on the grounds that it would not have taken place if she had been treated properly during her first visit. We drafted a letter for our client to sign telling the hospital to bill the patient. We knew that when Pat received the bill, she would take it to her attorney, who was already suing the grocery store for negligence. The attorney would, as a matter of course, request the medical records of the hospital visit; when he read them, he would find the damning Discharge Summary.
• Carlos was a 36-year-old man with a malignant brain tumor. During the operation to remove the tumor, the surgeons at N.B.I. Medical Center discovered that it extended from his left frontal lobe into his left nasal cavity. Following the surgery Carlos underwent four months of chemotherapy. Nine months after that, our client sent us the four unpaid chemotherapy bills, one for each month of treatment: $37,520, $39,021, $37,996 and $40,481.
When we examined the medical records, we found that the documentation necessary to verify many of the charges was missing. We decided to submit audit findings on just the first bill, to see whether the hospital could find the missing documentation. After looking for nearly three months, the hospital could not find the missing documentation, so it wrote off the entire $6,470 that we had disputed. Our client then paid the undisputed portion of the bill.
We quickly submitted audit findings on the three other bills, but by that time they had been sent to the hospital's collection agency. The hospital asked its collection agency to return the bills, so that it could write off the disputed portions and be paid for the undisputed portions, but the collection agency refused to return the bills to the hospital. The collection agency wanted to try to collect the entire amount of all three bills. For nearly four months the hospital and the collection agency engaged in a tug of war over the three bills before the hospital finally gave up.
The collection agency then triumphantly sent us, as proof that the charges that we had disputed were valid, the very same pages of medical records that we had used to prepare our audit findings. The missing documentation was, of course, still missing. Not at all triumphantly, the collection agency then wrote off the entire $17,619 that we had disputed on the three bills, and our client paid the undisputed balances. Our audits reduced the four bills by 15.5 percent.
Meanwhile, after Carlos (you remember Carlos, the patient) had finished up chemotherapy, he underwent radiation therapy. The last we heard, he was cancer-free, much to the relief of his wife and two young children.
******* We will add more success stories as time permits. |
