The case of the two Grace Elliotts: A medical billing mystery

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

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 university break in 2013, Elliott, then 22, started to really feel faint and feverish whereas visiting her dad and mom 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 recognized 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 keep in mind as a result of that was some huge cash for me as an undergrad,” stated Elliott, now 31.

She recovered and finally moved to California to show preschool. Venice Regional Medical Middle was purchased by Group 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 dwelling along with her husband in San Francisco, and Grace A. Elliott, 81, a retiree in Venice, Florida.
• Medical Providers: 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.
• Whole Invoice: $1,170, the affected person’s accountability 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: This can be a case of mistaken id, 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 stated. She “instantly knew one thing was fallacious.”

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 stated that accessing the fallacious 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 no less than 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 sort of factor that may undoubtedly occur,” stated Shannon Hartsfield, a Florida legal professional 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 fallacious button, after which not verify [the current patient’s] date of delivery 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. However it took her practically a 12 months of hours-long cellphone calls to undo the injury.

At first, anxious that she had been the sufferer of id 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 replica 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 acquired a discover that the company workplace had offered the debt to a group company known as Medical Knowledge 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 assumed, “Properly, I will simply work with them instantly,'” Grace E. Elliott stated.

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

“A group company, as a enterprise affiliate of a hospital, has an obligation to make sure that the fallacious affected person’s data isn’t shared,” Hartsfield stated.

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 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 attraction was additionally denied. She was informed to contact the hospital to clear up the problem. However as a result of the well being system had lengthy since offered the debt, Elliott stated, she received 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 acquired a name from Stanley Padfield, the Venice hospital’s outgoing privateness officer and director of well being data administration. “He stated, “It is taken care of,'” Elliott stated, including that she was relieved however skeptical. “I’ve heard that time and again.”

Elliott stated Padfield informed her that she had turn into listed as Grace A. Elliott’s guarantor, that means she was legally chargeable for the debt of a girl she had by no means met.

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

Padfield stated the error began with a “registration clerk,” who he stated had “acquired further privateness training on account of this incident.”

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

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

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

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

This, consultants stated, is the darkish secret of id points: As soon as a mistake has been entered right into a database, it may be remarkably troublesome to repair. And such incorrect data can stay for generations.

For sufferers, which means it is essential to assessment the knowledge 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 regularly. 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 title, a drugs not (or by no means) taken, or an inaccurate prognosis.

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

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

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

2022 Kaiser Well being Information.

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