Billed for a Medical Procedure that Never Occured

parapluie · 17-10-2014 5:54pm #1

Hi everyone, not sure if this is the correct place to ask this so please move it if necessary.

In September I received a bill through a medical billing company for a procedure carried out in a particular Dublin hospital on a date in August. The bill came with a letter requesting that I fill out the enclosed health insurance claim form (for a particular insurance provider) in reference to this procedure.

The thing is I have never been referred to the consultant named, I have never had the procedure concerned, I have never set foot in the hospital concerned and I do not have insurance with the company whose claim form they sent me.

I contacted the billing company to discuss matters and made it clear that this bill could not relate to me. They said they would investigate and would get back to me. This week (one month on) they contacted me to say they have contacted the consultant and investigated and that I definitely had the procedure done on that day in this hospital and that they will now be re-issuing the bill and a new claim form for my actual insurance company. They seem to think I am confused as a technician may have actually carried out the procedure so I may not have seen this consultant. I made it clear that I am not confused and that this procedure never happened, but they won't listen.

I contacted my insurer to let them know to expect a claim that is fraudulant. I tried to contact the hospital and the consultant's secretary but can't get through.

I would like some advice on the best way to follow up on this matter. Is this identity theft? Who had this procedure and said they were me? How can I prove it was not me? Surely there must be a GP referral letter relating to this patient - could I find that out to see how this has occurred? I'm worried this will become a bigger issue in terms of identity theft and my credit rating etc. Who should I contact and how should I go about it?

Thank you for reading this long post and for any replies.

davo10 · 17-10-2014 6:16pm

parapluie wrote: »

Hi everyone, not sure if this is the correct place to ask this so please move it if necessary.

In September I received a bill through a medical billing company for a procedure carried out in a particular Dublin hospital on a date in August. The bill came with a letter requesting that I fill out the enclosed health insurance claim form (for a particular insurance provider) in reference to this procedure.

The thing is I have never been referred to the consultant named, I have never had the procedure concerned, I have never set foot in the hospital concerned and I do not have insurance with the company whose claim form they sent me.

I contacted the billing company to discuss matters and made it clear that this bill could not relate to me. They said they would investigate and would get back to me. This week (one month on) they contacted me to say they have contacted the consultant and investigated and that I definitely had the procedure done on that day in this hospital and that they will now be re-issuing the bill and a new claim form for my actual insurance company. They seem to think I am confused as a technician may have actually carried out the procedure so I may not have seen this consultant. I made it clear that I am not confused and that this procedure never happened, but they won't listen.

I contacted my insurer to let them know to expect a claim that is fraudulant. I tried to contact the hospital and the consultant's secretary but can't get through.

I would like some advice on the best way to follow up on this matter. Is this identity theft? Who had this procedure and said they were me? How can I prove it was not me? Surely there must be a GP referral letter relating to this patient - could I find that out to see how this has occurred? I'm worried this will become a bigger issue in terms of identity theft and my credit rating etc. Who should I contact and how should I go about it?

Thank you for reading this long post and for any replies.

Relax, it's a case of mistaken identity. Did you give them your date of birth? The insurance company will not pay it if you are not a member, the hospital will have taken an insurance membership number at the time the procedure was done, the billing will relate to the membership number, not the individual. Two people with same name, they sent it to you instead of the other person on their computer system.

Phone the hospital, give them your date of birth, ask them to check if there are any other people with same name as you on their system.

parapluie · 17-10-2014 6:19pm

Thanks very much for your reply.

I have an unusual name so I think that's unlikely but I will check. Also, do you mean the billing company have me in their system or the hospital? How would either have my details as I've had no contact with either ever? My correct date of birth was pre-printed on the insurance claim form I was sent.

I know the first insurance company won't pay it as I don't have an account with them. The billing company are now sending out a claim form for my actual insurance company and will be billing them. But I have already let my insurance company know this is not legitimate. But if this doesn't get sorted then I would be personally liable for the bill - it says that on the bill that if you are not covered by insurance to log in and pay by card.

dudara · 17-10-2014 6:38pm

If the hospital thinks that it's you, then ask to see "your" records. Based on the information contained, you should be able to prove that it's not you, that you were elsewhere etc

parapluie · 17-10-2014 6:50pm

Thanks dudara.

Yes, that's what I had been thinking - if I could get a copy of the GP referral letter I could contact whatever GP it is or something. Would that be possible?

I thought of proving I was elsewhere for the day of the procedure I'm being billed for but I was at home, not in work or anything which would have been straight forward to show. Perhaps there could be more dates included in "my" files that might be more useful.

davo10 · 17-10-2014 6:56pm

dudara wrote: »

If the hospital thinks that it's you, then ask to see "your" records. Based on the information contained, you should be able to prove that it's not you, that you were elsewhere etc

If there is some confusion, under no circumstances will a hospital allow you to view medical records, it would be a serious breach of confidentiality if the records did not actually relate to the OP.

OP you will not be liable for the bill, this is an administrative mistake, they have the wrong membership number, wrong insurance company, wrong person etc. it's possible wrong insurance/personal details were imputed when invoice was generated. If they transposed two membership digits when imputing details for invoicing, your details would come up rather than the actual person.

Again, just phone/write to accounts department, give them your name, dob and address. Tell them to check with consultants secretary for the date you were supposed to have the procedure, she will set them straight.

17-10-2014 6:59pm

parapluie wrote: »

Thanks dudara.

Yes, that's what I had been thinking - if I could get a copy of the GP referral letter I could contact whatever GP it is or something. Would that be possible?

I thought of proving I was elsewhere for the day of the procedure I'm being billed for but I was at home, not in work or anything which would have been straight forward to show. Perhaps there could be more dates included in "my" files that might be more useful.

I doubt you could do that. It's up to them to prove that YOU had a procedure done. Let them have your GP's details and a copy of your signature, possibly from Passport or Driving licence.

parapluie · 17-10-2014 7:00pm

Ok. How would they get details for me at all? Would they get details by inputting an insurance number into some online system? Where did they get the information that I was with insurance company A when I'm not and never was? It just doesn't make sense. But I hope it will be as simple as talking to the consultant's secretary. I tried today but couldn't get through. The billing company say they already asked the consultant to check records and that I (someone with my name, address and date of birth) had the procedure done on that day in this hospital.

17-10-2014 7:02pm

parapluie wrote: »

Ok. How would they get details for me at all? Would they get details by inputting an insurance number into some online system? Where did they get the information that I was with insurance company A when I'm not and never was? It just doesn't make sense. But I hope it will be as simple as talking to the consultant's secretary. I tried today but couldn't get through. The billing company say they already asked the consultant to check records and that I (someone with my name, address and date of birth) had the procedure done on that day in this hospital.

Just get back on to them and tell them that they've made a mistake and that it's up to them to sort it out.

bisset · 17-10-2014 7:08pm

Make a complaint using the formal complaints procedure. Organisations such as hospitals usually have a specified number of days in which to respond to a formal complaint. As they have your date of birth you could also probably make a complaint to the Data Protection Commissioner.

davo10 · 17-10-2014 7:09pm

parapluie wrote: »

Ok. How would they get details for me at all? Would they get details by inputting an insurance number into some online system? Where did they get the information that I was with insurance company A when I'm not and never was? It just doesn't make sense. But I hope it will be as simple as talking to the consultant's secretary. I tried today but couldn't get through. The billing company say they already asked the consultant to check records and that I (someone with my name, address and date of birth) had the procedure done on that day in this hospital.

You are thinking about this too much. If a family member was there, your details may be in system as a next of kin, etc. Hospital can confirm details with insurance company, if membership number was wrongly recorded, they may have gotten wrong billing details.

The fact that all details are wrong show that this does not relate to you, it was a mistake. If all the details were correct, membership number/insurance company/ dob/ etc and a claim was being made, then you would be right to be concerned but this is just an administrative error.

Demonical · 17-10-2014 7:10pm

What kind of procedure was meant to have been carried out? Would it have left any sort of a scar on the person whom it was carried out on? You obviously wont have this scar as the operation wasn't carried out on you? Maybe it was dental work or something. That surely could be proved to not have been done to you...

davo10 · 17-10-2014 7:10pm

bisset wrote: »

Make a complaint using the formal complaints procedure. Organisations such as hospitals usually have a specified number of days in which to respond to a formal complaint. As they have your date of birth you could also probably make a complaint to the Data Protection Commissioner.

Or you could just realise that it's a case of mistaken identity. Hospitals are linked in to insurance company claim/membership data, if the wrong membership number is typed, someone else's billing address is generated. Simple mistake. There is no data breach, OP was not given the name of the person who had the procedure, it's just a billing details mistake.

parapluie · 17-10-2014 7:21pm

Thanks for all the replies.

At first I was relaxed about this and did think it's just a mistake and will be sorted no problem. But now the billing company are being quite snotty about it all saying their investigations show it was me and so I'm just looking for advice on how to proceed to ensure this is sorted quickly. I will certainly contact the hospital and the consultant's secretary first thing Monday and hopefully it will be sorted quickly.

Even if it is sorted quickly though I have to say it concerns me that a hospital I have never had contact with could get my name, address and date of birth. Nobody related to me has ever been to the hospital - they definitely would never have been given my details. It's just weird.

The procedure was radiography so no scars or anthing. Hopefully I won't need to be proving anything though.

Thanks

ytpe2r5bxkn0c1 · 17-10-2014 7:52pm

Just ask for a copy of the referral letter from your GP.

rock22 · 18-10-2014 8:33am

bisset wrote: »

Make a complaint using the formal complaints procedure. Organisations such as hospitals usually have a specified number of days in which to respond to a formal complaint. As they have your date of birth you could also probably make a complaint to the Data Protection Commissioner.

You will need to do this. A billing company will not be in a position to investigate this so you need to make the complaint to the hospital concerned and possibly to the data commissioner

This highlights a major reason for cost inflation in the health service. Radiographers and Pathologists can bill for , and get paid for, procedures and tests they had no role in carrying out and may not even have been in the hospital at the time. The sums of money involved are significant.

Also inform your insurance company , by letter, that you were never in the hospital and had no procedure.

By the way, there is no chance that a name given as next of kin could ever be confused with a patient's name.

davo10 · 18-10-2014 9:04am

rock22 wrote: »

You will need to do this. A billing company will not be in a position to investigate this so you need to make the complaint to the hospital concerned and possibly to the data commissioner

This highlights a major reason for cost inflation in the health service. Radiographers and Pathologists can bill for , and get paid for, procedures and tests they had no role in carrying out and may not even have been in the hospital at the time. The sums of money involved are significant.

Also inform your insurance company , by letter, that you were never in the hospital and had no procedure.

By the way, there is no chance that a name given as next of kin could ever be confused with a patient's name.

The wrong insurance membership number typed in computer will though. There was no data breach, OP was not given confidential details, ops details were not given to anyone else. Simple administrative mistake.

Every insurer forwards details of hospital procedures and payments to the insured. Do you honestly think radiographers are randomly picking people and claiming for procedures, knowing that the person is going to get a payment report from the insurer?

Can you provide some evidence for your claim that pathologists and radiographers fraudulently claim significant sums?

parapluie · 18-10-2014 10:58am

davo10 you seem certain this is down to an incorrect inurance number being typed into a system. If that is the case, and the hospital typed in my number accidently, why did the hospital think I was with insurer A instead of insurer B? They don't have any policy number for me by the way, right or wrong. That is why the billing company forwarded an invoice and claim form to me a month after the procedure. According to them I named my insurer on the day but didn't have the policy number available so the bill and form had to be sent out.

Also no insurance company forwarded any details about procedures and paymets to me. It is a billing company working on behalf of the consultant who has contacted me.

Just to say that I certainly don't think any medical staff are fraudulantly billing anyone. I think it more likely that someone has impersonated me to avail of private healthcare for free. But I'm still hoping that's not the case and it is just an error that I can't understand.

davo10 · 18-10-2014 11:34am

parapluie wrote: »

davo10 you seem certain this is down to an incorrect inurance number being typed into a system. If that is the case, and the hospital typed in my number accidently, why did the hospital think I was with insurer A instead of insurer B? They don't have any policy number for me by the way, right or wrong. That is why the billing company forwarded an invoice and claim form to me a month after the procedure. According to them I named my insurer on the day but didn't have the policy number available so the bill and form had to be sent out.

Also no insurance company forwarded any details about procedures and paymets to me. It is a billing company working on behalf of the consultant who has contacted me.

Just to say that I certainly don't think any medical staff are fraudulantly billing anyone. I think it more likely that someone has impersonated me to avail of private healthcare for free. But I'm still hoping that's not the case and it is just an error that I can't understand.

Crickey, if they didn't have an insurance number to start with and do have your date of birth, it does sound like someone impersonated you, and it had to be someone with enough info to have access to your date of birth.

rock22 · 18-10-2014 5:38pm

davo10 wrote: »

Can you provide some evidence for your claim that pathologists and radiographers fraudulently claim significant sums?

I never said fraudulently, read my post again. For information of this ask VHI

Sheldons Brain · 18-10-2014 6:42pm

State that you do not believe it is you, but ask them for your records. If they refuse you the records because of doubt over your identity then they cannot charge you for the treatment. If they release records then report them to the Data Protection Commissioner.

d9oiu2wk07blr5 · 19-10-2014 1:48pm

My reading of this is that the billing has come from a private medical billing service rather than from hospital accounts. Some consultants who are operating in the private sector contract a private billing company to handle all their accounts. Firstly, dispute the billing in writing with the company concerned. There should be a medical registration number or patient number on the billing. I'd also make written complaint to the hospital notifying them that you had received a billing in error, that you are not a patient of that hospital, you have never attended that hospital, and that you want the matter fully investigated in accordance with their complaints procedure. If after the matter has been fully investigated, they are still maintaining the stance that the billing was correct, then seek access to all hospital records under S7 of FOI if it's a public or S4 of Data Protection if it's a private hospital.

If the billing is from the consultant, there should also be a corresponding billing from the hospital for the cost of procedure that was carried out in that hospital. Under no circumstances provide either the private billing company or the hospital with details of your PHI membership number, the name of your GP, or any private sensitive data of a medical nature.

If the matter isn't resolved internally, you can refer the matter to the Office of the Ombudsman if it's a public hospital. I'd also consider making a complaint to the Office of the Data Protection Commissioner.

foggy_lad · 19-10-2014 2:08pm

parapluie wrote: »

I think it more likely that someone has impersonated me to avail of private healthcare for free. But I'm still hoping that's not the case and it is just an error that I can't understand.

This is very likely and is identity theft. the person would just have to find something with your details on it in your rubbish and they can use those details to claim they are you in many places including hospitals.

Billed for a Medical Procedure that Never Occured

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