The Case of Two Grace Elliotts: A Medical Billing Mystery

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Earlier this year, Grace Elizabeth Elliott received a mysterious hospital bill for medical care she never received.

She soon discovers how far-reaching a clerical error can be—even transcontinental—and how frustrating it can be to fix it.

During college break in 2013, Elliott, then 22 years old, began to feel sick and feverish while visiting her parents in Venice, Florida, about an hour south of Tampa. Her mother, a nurse, drove her to a facility that locals simply called Venice Hospital.

inside emergency departmentElliott was diagnosed with a kidney infection and was hospitalized overnight before being discharged with a prescription for antibiotics, a common treatment for the disease.

“My hospital bill was about $100, I remember that because it was a lot of money for me as a college student,” says Elliott, now 31.

She recovered and eventually moved to California to teach preschool. Venice Regional Medical Center was purchased by Public Health Systems, based in Franklin, Tennessee, in 2014 and was eventually renamed ShorePoint Health Venice.

A kidney infection and an overnight stay in the emergency room will only be a memory for Elliott.

Then another bill came.

  • The patients: Grace E. Elliott, 31, a preschool teacher who lives with her husband in San Francisco, and Grace A. Elliott, 81, a retired person from Venice, Florida.
  • Medical Services: For Grace E., one emergency department visit and overnight stay, along with antibiotics to treat a kidney infection in 2013. For Grace A., a shoulder replacement and rehabilitation services in 2021.
  • Provider: Venice Regional Medical Center, later renamed ShorePoint Health Venice.
  • Total bill: $1,170, patient responsibility for shoulder replacement service, after adjustment and payment of $13,210.21 by a health plan no connection to Elliott. Initial fees are $123,854.14.
  • What it brings: This is a case of mistaken identity, a billing mystery that begins at the hospital registration desk and doesn’t end until months after the records are turned over to a collection agency.

Earlier this year, Grace E. Elliott’s mother opened a bill from ShorePoint Health Venice for her daughter and asked for more than $1,000 for recent hospital services, Elliott said. She “instantly knew something was wrong.”

Months of investigation eventually revealed that the bill was for Grace Ann Elliott, a much older woman who underwent shoulder replacement and rehabilitation services at a Venice hospital last year.

Experts say mistakenly accessing patient records by mistake by name is a common mistake — but one that often exists for safeguards, such as checking a patient’s photo ID patient.

The hospital treated at least two Grace Elliotts. When Grace A. Elliott arrived to replace the role, a hospital employee mistakenly took Grace E. Elliott’s account.

“This is definitely possible,” said Shannon Hartsfield, a Florida attorney who specializes in healthcare privacy violations. (Hartsfield does not represent anyone involved in this case.) “All kinds of human error happen. A worker could pull up a name, hit the wrong button, and then fail the test. [the current patient’s] date of birth to confirm.”

It was a seemingly obvious error: the younger Elliott was billed for a procedure she didn’t have at a hospital she hadn’t visited in years. But it took her nearly a year of hour-long phone calls to repair the damage.

At first, worried that she was a victim of identity theft, Grace E. Elliott contacted ShorePoint Health Venice and was transferred from one department to another. At one point, a billing officer revealed to Elliott the date of birth the hospital had on the shoulder replacement patient’s records – that date of birth was not hers. Elliott then sent the hospital a copy of her identification.

It took weeks for an administrator at ShorePoint’s corporate office in Florida to acknowledge the hospital’s error and promise to correct it.

However, in August, Grace E. Elliott received notice that the corporate office had sold the debt to a collection agency called Medical Data Systems. Although the hospital admitted its mistake, the agency was still hunting Grace E. Elliott to demand money to pay for Grace A. Elliott’s shoulder surgery.

“I thought, ‘Well, I’ll work directly with them,'” said Grace E. Elliott.

Her appeal was denied. The medical data system said in the denial letter that it had contacted the hospital and confirmed the name and address on file. The agency also attached a copy of Grace A. Elliott’s expired driver’s license to Grace E.—along with several pages of the elderly woman’s driver’s license. medical information—to support its conclusion.

“A collection agency, as a hospital business partner, has an obligation to ensure that false patient information is not shared,” says Hartsfield.

In an email to KHN, Cheryl Spanier, vice president of the collection agency, wrote that “MDS follows all state and federal rules and regulations.” Spanier declined to comment on Elliott’s case, saying she needs the written consent of both health systems and patients to do so.

Elliott’s second appeal was also denied. She was asked to contact the hospital to resolve the issue. But because the health system had long sold the debt, Elliott said, she had no incentive to try to get ShorePoint Health Venice to help her. The hospital closed in September.

In mid-November, shortly after a reporter contacted ShorePoint Health, which operates hospitals and other facilities in Florida, Grace E. Elliott received a call from Stanley Padfield, the rights officer Outgoing privacy officer of Venice Hospital and director of medical information management. “He said, ‘It’s all worked out,'” Elliott said, adding that she was relieved but still skeptical. “I’ve heard that over and over.”

Elliott said Padfield told her she was listed as a guarantor of Grace A. Elliott, meaning she was legally responsible for the debt of a woman she had never met.

Elliott promptly received a letter from Padfield stating that ShorePoint Health had removed her information from Grace A. Elliott’s account and confirmed that she was not reported to any credit bureaus. The letter said her information had been removed from the collection agency’s database and acknowledged that the hospital’s remedy was initially “not properly communicated” to the collections.

Padfield said the error started with a “registration officer” who he said was “gained further privacy education following this incident.”

Devyn Brazelton, marketing coordinator for ShorePoint Health, told KHN that the hospital believes the error is “an isolated incident.”

Using the date of birth provided by hospital staff, Elliott was able to contact Grace A. Elliott and explain the confusion.

“I’m a bit sad right now,” Grace A. Elliott told KHN the day she learned of the billing error and revealed her medical information.

Lesson learned: Grace E. Elliott said that when she asked Padfield, Venice hospitalof the outgoing security officer, whether she could do something to combat such an apparent case of identity confusion, he replied: “Probably not.”

Experts say this is the dark secret of identity problems: Once an error has been entered into the database, it can be very difficult to correct. And such inaccurate information can persist for generations.

For patients, that means it’s important to review the information on the patient portal—the online medical record that many providers use to manage things like scheduling appointments, scheduling arrange medical recordand answer patient questions.

One disadvantage of electronic medical records is that errors are easily propagated and repeated frequently. It is important to challenge and correct errors in medical records early and vigorously, with every available document. That’s true whether the problem is an incorrect name, a medication that is no longer (or never) used, or an incorrect diagnosis.

The process of amending records can be “very complicated,” Hartsfield said. “But now that patients can see more and more of their medical records, they’ll want those revisions, and the health system and their stakeholders need to be prepared for that.”

Grace A. Elliott told KHN that she had received a call from ShorePoint Health a few months earlier that she owed money to replace the role.

She asked for a copy of the bill, she told KHN. Months after she asked, it still hadn’t arrived.

Kaiser Health Bulletin 2022.

Distributed by Tribune Content Agency, LLC.

quote: The Case of Two Grace Elliotts: A Medical Billing Mystery (2022, December 28) retrieved December 28, 2022 from grace-elliotts-medical-billing.html

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