The case of the 2 Grace Elliotts: A medical billing thriller

Earlier this 12 months, Grace Elizabeth Elliott acquired a mysterious hospital invoice for medical care she had by no means obtained.

She quickly found how far a clerical error can attain—even throughout a continent—and the way irritating it may be to repair.

Throughout a school break in 2013, Elliott, then 22, started to really feel faint and feverish whereas visiting her mother and father in Venice, Florida, about an hour south of Tampa. Her mom, a nurse, drove her to a facility that locals knew merely as Venice Hospital.

Within the emergency division, Elliott was identified with a kidney an infection and held in a single day earlier than being discharged with a prescription for antibiotics, a typical remedy for the sickness.

“My hospital invoice was about $100, which I bear in mind as a result of that was some huge cash for me as an undergrad,” mentioned Elliott, now 31.

She recovered and finally moved to California to show preschool. Venice Regional Medical Middle was purchased by Neighborhood Well being Programs, primarily based in Franklin, Tennessee, in 2014 and finally renamed ShorePoint Well being Venice.

The kidney an infection and in a single day keep within the ER would have been little greater than a reminiscence for Elliott.

Then one other invoice got here.

• The Sufferers: Grace E. Elliott, 31, a preschool trainer residing along with her husband in San Francisco, and Grace A. Elliott, 81, a retiree in Venice, Florida.
• Medical Companies: For Grace E., an emergency division go to and in a single day keep, plus antibiotics to deal with a kidney an infection in 2013. For Grace A., a shoulder alternative and rehabilitation companies in 2021.
• Service Supplier: Venice Regional Medical Middle, later renamed ShorePoint Well being Venice.
• Complete Invoice: $1,170, the affected person’s duty for shoulder alternative companies, after changes and funds of $13,210.21 by a well being plan with no connection to Elliott. The preliminary costs had been $123,854.14.
• What Offers: It is a case of mistaken identification, a billing thriller that began at a hospital registration desk and did not finish till months after the file had been handed over to a group company.

Early this 12 months, Grace E. Elliott’s mom opened a invoice from ShorePoint Well being Venice that was addressed to her daughter and sought greater than $1,000 for latest hospital companies, Elliott mentioned. She “instantly knew one thing was mistaken.”

Months of sleuthing finally revealed that the invoice was meant for Grace Ann Elliott, a a lot older girl who underwent a shoulder alternative process and rehabilitation companies on the Venice hospital final 12 months.

Consultants mentioned that accessing the mistaken affected person’s file due to a reputation mix-up is a typical error—however one for which safeguards, like checking a affected person’s picture identification, often exist.

The hospital had handled at the very least two Grace Elliotts. When Grace A. Elliott confirmed up for her shoulder alternative, a hospital worker pulled up Grace E. Elliott’s account by mistake.

“That is the form of factor that may positively occur,” mentioned Shannon Hartsfield, a Florida lawyer who makes a speciality of well being care privateness violations. (Hartsfield doesn’t signify anybody concerned on this case.) “All types of human errors occur. A employee can pull up the names, click on the mistaken button, after which not examine [the current patient’s] date of start to verify.”

It was a seemingly apparent error: The youthful Elliott was billed for a process she did not have by a hospital she had not visited in years. But it surely took her almost a 12 months of hours-long cellphone calls to undo the injury.

At first, frightened that she had been the sufferer of identification theft, Grace E. Elliott contacted ShorePoint Well being Venice and was bounced from one division to a different. At one level, a billing worker disclosed to Elliott the birthdate the hospital had on file for the affected person who had the shoulder alternative—it was not hers. Elliott then despatched the hospital a duplicate of her ID.

It took weeks for an administrator at ShorePoint’s company workplace in Florida to confess the hospital’s error and promise to right it.

In August, although, Grace E. Elliott obtained a discover that the company workplace had offered the debt to a group company known as Medical Information Programs. Regardless that the hospital had acknowledged its error, the company was coming after Grace E. Elliott for the stability due for Grace A. Elliott’s shoulder surgical procedure.

“I believed, “Effectively, I am going to simply work with them straight,'” Grace E. Elliott mentioned.

Her attraction was denied. Medical Information Programs mentioned in its denial letter that it had contacted the hospital and confirmed the identify and tackle on file. The company additionally included a duplicate of Grace A. Elliott’s expired driver license to Grace E.—together with a number of pages of the older girl’s medical info—in help of its conclusion.

“A set company, as a enterprise affiliate of a hospital, has an obligation to make sure that the mistaken affected person’s info is just not shared,” Hartsfield mentioned.

In an e mail to KHN, Cheryl Spanier, a vice chairman of the gathering company, wrote that “MDS follows all state and federal guidelines and laws.” Spanier declined to touch upon Elliott’s case, saying she wanted the written consent of each the well being system and the affected person to take action.

Elliott’s second attraction was additionally denied. She was advised to contact the hospital to clear up the difficulty. However as a result of the well being system had lengthy since offered the debt, Elliott mentioned, she acquired no traction in attempting to get ShorePoint Well being Venice to assist her. The hospital closed in September.

In mid-November, shortly after a reporter contacted ShorePoint Well being, which operates different hospitals and services in Florida, Grace E. Elliott obtained a name from Stanley Padfield, the Venice hospital’s outgoing privateness officer and director of well being info administration. “He mentioned, “It is taken care of,'” Elliott mentioned, including that she was relieved however skeptical. “I’ve heard that time and again.”

Elliott mentioned Padfield advised her that she had change into listed as Grace A. Elliott’s guarantor, which means she was legally answerable for the debt of a lady she had by no means met.

Elliott quickly obtained a letter from Padfield stating that ShorePoint Well being had eliminated her info from Grace A. Elliott’s account and confirmed that she had not been reported to any credit score companies. The letter mentioned her info had been faraway from the gathering company’s database and acknowledged that the hospital’s repair initially “was not appropriately communicated” to collections.

Padfield mentioned the error began with a “registration clerk,” who he mentioned had “obtained further privateness schooling on account of this incident.”

Devyn Brazelton, advertising and marketing coordinator for ShorePoint Well being, advised KHN the hospital believes the error was “an remoted incident.”

Utilizing the date of start offered by a hospital employee, Elliott was in a position to contact Grace A. Elliott and clarify the mix-up.

“I am a bit of upset proper now,” Grace A. Elliott advised KHN on the day she discovered concerning the billing error and disclosure of her medical info.

The Takeaway: Grace E. Elliott mentioned that when she requested Padfield, the Venice hospital’s outgoing privateness officer, whether or not she may have executed one thing to battle such an apparent case of mistaken identification, he replied, “In all probability not.”

This, specialists mentioned, is the darkish secret of identification points: As soon as a mistake has been entered right into a database, it may be remarkably troublesome to repair. And such incorrect info can reside for generations.

For sufferers, meaning it is essential to overview the data on affected person portals—the net medical profiles many suppliers use to handle issues like scheduling appointments, organizing medical data, and answering affected person questions.

One draw back of digital medical data is that errors unfold simply and repeat steadily. You will need to problem and proper errors in medical data early and forcefully, with each little bit of documentation accessible. That’s true whether or not the issue is an incorrect identify, a medicine not (or by no means) taken, or an inaccurate prognosis.

The method of amending a report could be “very concerned,” Hartsfield mentioned. “However with sufferers ready now to see an increasing number of of their medical data, they’re going to need these amendments, and well being programs and their associated entities have to get ready for that.”

Grace A. Elliott advised KHN that she had obtained a name from ShorePoint Well being in the last few months indicating that she owed cash for her shoulder alternative.

She requested for a duplicate of the invoice, she advised KHN. Months after she requested, it nonetheless hadn’t arrived.

2022 Kaiser Well being Information.

Distributed by Tribune Content material Company, LLC.