Mistaken identity leads to big hospital bill mix-up : Shots


In 2013, Grace E. Elliott spent an evening in a hospital in Florida for a kidney an infection that was handled with antibiotics. Eight years later, she bought a big invoice from the well being system that purchased the hospital. This invoice was for an unrelated surgical process she did not want and by no means obtained. It was a case of mistaken identification, she knew, however proving that wasn’t straightforward.

Shelby Knowles for KHN

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Shelby Knowles for KHN

In 2013, Grace E. Elliott spent an evening in a hospital in Florida for a kidney an infection that was handled with antibiotics. Eight years later, she bought a big invoice from the well being system that purchased the hospital. This invoice was for an unrelated surgical process she did not want and by no means obtained. It was a case of mistaken identification, she knew, however proving that wasn’t straightforward.

Shelby Knowles for KHN

Earlier this 12 months, Grace Elizabeth Elliott bought 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 dad and mom in Venice, Fla., which is 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 recognized with a kidney an infection and held in a single day earlier than being discharged with a prescription for antibiotics, a standard therapy for the sickness.

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

She recovered and ultimately moved to California to show preschool. Venice Regional Medical Heart was purchased by Neighborhood Well being Programs, based mostly in Franklin, Tenn., in 2014 and ultimately renamed ShorePoint Well being Venice.

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

Then one other invoice got here.

The Sufferers: Grace E. Elliott, 31, a preschool instructor dwelling together with her husband in San Francisco, and Grace A. Elliott, 81, a retiree in Venice, Fla.

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 substitute and rehabilitation companies in 2021.

Service Supplier: Venice Regional Medical Heart, later renamed ShorePoint Well being Venice.

Whole Invoice: $1,170, the affected person’s accountability for shoulder substitute companies, after changes and funds of $13,210.21 by a well being plan with no connection to Grace E. Elliott. The preliminary costs have been $123,854.14.

What Provides: 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 collections 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 unsuitable.”

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

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

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

“That is the type of factor that may positively occur,” mentioned Shannon Hartsfield, a Florida lawyer who focuses on well being care privateness violations. (Hartsfield doesn’t characterize anybody concerned on this case.) “Every kind of human errors occur. A employee can pull up the names, click on the unsuitable button, after which not examine [the current patient’s] date of start to substantiate.”

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. Nevertheless it took her practically a 12 months of hours-long cellphone calls to undo the harm.

At first, anxious 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 substitute — 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 appropriate it.

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

“I believed, ‘Nicely, I am going to simply work with them immediately,'” Grace E. Elliott mentioned.

Her enchantment was denied. Medical Information Programs mentioned in its denial letter that it had contacted the hospital and confirmed the identify and handle 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 assist of its conclusion.

“A group company, as a enterprise affiliate of a hospital, has an obligation to make sure that the unsuitable affected person’s info will not be shared,” Hartsfield mentioned.

In an electronic mail to KHN, Cheryl Spanier, a vice chairman of the collections company wrote that “MDS follows all state and federal guidelines and rules.” 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 enchantment was additionally denied. She was instructed 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 bought no traction in making an attempt to get ShorePoint Well being Venice to assist her. The hospital closed in September.

Decision: 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 instructed her that she had turn into listed as Grace A. Elliott’s guarantor, that means she was legally answerable for the debt of a girl 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 extra privateness training because of this incident.”

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

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

“I am somewhat upset proper now,” Grace A. Elliott instructed KHN on the day she realized 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 carried out one thing to combat such an apparent case of mistaken identification, he replied, “Most likely not.”

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

For sufferers, meaning it is essential to periodically evaluate the data in your affected person portal — the net medical profile 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 ceaselessly. It is very important problem and proper errors in medical data early and forcefully, with each little bit of documentation obtainable. 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 document may be “very concerned,” Hartsfield mentioned. “However with sufferers ready now to see increasingly more of their medical data, they’re going to need these amendments, and well being techniques and their associated entities must get ready for that.”

Grace A. Elliott instructed KHN that she had obtained a name from ShorePoint Well being in the previous couple of months indicating that she owed cash for her shoulder substitute.

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

KHN (Kaiser Well being Information) is a nationwide, editorially unbiased program of KFF (Kaiser Household Basis).