Should we be suspicious?

[athena53]

DH has been treated for the last several months for a leg ulcer that was not healing on its own. This has involved weekly visits, then biweekly, to the local medical center. It's almost completely healed.

When the bills for the visits started to arrive and I dug into the details, it turned out that he was getting two bills on the same day for each visit- one for $225 and one for $670. Same date, same doctor, even the same treatment code. The one for $670 had two hospital logos on it- the local medical center and "Florida Hospital- Deland"- which exists but, to our knowledge, has no affiliation with our local hospital here in the Midwest.

So, I called the billing number, which was affiliated with the local hospital. The employee could not tell me why the name of the FL hospital was on some of the bills although both bills showed up in her system. They had two different Patient Numbers, though- identical except that one had a suffix of -1 and one had a suffix of -3.

Medicare has paid on these claims and they've been sent onto the Medicare Supplement insurer- but I'm still concerned. I'm well aware of the extent of Medicare fraud and figure that vigilant consumers are the first line of defense.

Would this bother you and would you pursue it? We have little to gain except liability for any copayment on the $670 charges if they turn out to be phony- but I'm more concerned about doing the right thing.

 

[REWahoo]

Sounds fishy to me. You can always report it as suspect and let the govt. sort it out: https://www.medicare.gov/forms-help...d-and-abuse/report-fraud/reporting-fraud.html

 

[travelover]

It would bother me. Medicare fraud is common.

 

[dirt_dobber]

#1 yes - investigate thoroughly
#2 look into applying honey as a treatment - seriously.

 

[spncity]

Ask at the front desk at the next visit. They should have a billing person who is submitting this paperwork to the accounting/billing office. Ask about the patient numbers specifically.

 

[athena53]

Thanks for the insights. DH did drop off a copy of two of the bills at the front desk with my questions and asked that they be forwarded to the billing people but I'll tell him to FIND a billing person at his next visit and ask about the duplicate patient numbers. He's less engaged in this than I am; I worked in insurance for almost 40 years and hate fraud. If that's what this is, I want to help uncover it.

 

[travelover]

..........#2 look into applying honey as a treatment - seriously.

I believe that granulated sugar has also been used on antibiotic resistant bacteria.

 

[Walt34]

Sounds fishy to me. You can always report it as suspect and let the govt. sort it out: https://www.medicare.gov/forms-help...d-and-abuse/report-fraud/reporting-fraud.html

Yes, do this.

 

[athena53]

I believe that granulated sugar has also been used on antibiotic resistant bacteria.

I've heard of honey, but not this. Will mention to DH but, as I noted, it's almost healed at this point so he may stay the course.

 

[MRG]

I've heard of honey, but not this. Will mention to DH but, as I noted, it's almost healed at this point so he may stay the course.

Sounds like some woo from a particular food social media site.

 

[Meadbh]

Sounds like some woo from a particular food social media site.

Not quite.

Foot Technology, Part 2 of 2: Use of Sugar on the Healing of Diabetic Ulcers: A Review

 

[MRG]

Not quite.

Foot Technology, Part 2 of 2: Use of Sugar on the Healing of Diabetic Ulcers: A Review

Wow, thanks for that! I had zero notion that sugar had medical uses.

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[John Galt III]

I had an ultrasound done recently at a clinic in a hospital network. I was monitoring the ins co website to see the claim being processed. The first entry was for a clinic I never went to. The claim status was *in process*. The next day the entry for that clinic disappeared and 2 entries for the hospital appeared. One entry for the actual ultrasound and the other one for the radiologist interpretation of the ultrasound. They were *in process* for 2 days, then approved, I thought that was it, but then 2 other entries appeared. One for an ultrasound at a clinic associated with the hospital (although not the clinic I went to) and one for interpretation of the ultrasound. They both had a specific doctor's name associated. And not the same procedure codes as the 2 original hospital entries. These 2 clinic entries were *in process* for 2 days, then approved. As far as I know, they are legit, but who knows, right? Sounds like subcontractors all over the place trying to get a piece of the action, possibly.

 

[Sunset]

Watch it carefully.
A relative had a sore that refused to heal on his foot, he treated it with something that sounded like a home remedy, at that point I stopped listening so I don't know the names.
Point of the story is about a week or more later it all turned into the flesh eating disease, they did multiple amputations to try to save most of the leg.

Now he has a peg leg and now he does some insulin to treat his diabetes.

 

[athena53]

Thanks, sunset. DH isn't diabetic. They did a scan of his arteries and found some poor circulation but not enough to insert stents. He's sticking with the treatments. We want to go to Iceland again this year and a peg leg would definitely hamper his mobility!

 

[travelover]

......... We want to go to Iceland again this year and a peg leg would definitely hamper his mobility!

Although it might give you an in with the local pirates.

 

[Letj]

Yes, vigorously pursue it. Florida is the Medicaid and Medicare days capital.


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[Letj]

I meant fraud capital.


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[Meadbh]

I meant fraud capital.


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You know you can edit, right?
At least for a time.

 

[Letj]

Thanks Meadbh! Didn't know that.


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[Sunset]

Thanks, sunset. DH isn't diabetic. They did a scan of his arteries and found some poor circulation but not enough to insert stents. He's sticking with the treatments. We want to go to Iceland again this year and a peg leg would definitely hamper his mobility!

The diabetes has the effect of causing poor circulation in small blood vessels, which is why gangrene can set in the toes, fingers of diabetics.

Knowing your DH has poor circulation will be something to watch as you know.

The main point I failed to make earlier is that persistent sores that don't heal quickly allow the bacteria that causes flesh eating disease to get into the body which is incredibly dangerous and stubborn to treat, resulting in rapid drastic measures.

 

[athena53]

The main point I failed to make earlier is that persistent sores that don't heal quickly allow the bacteria that causes flesh eating disease to get into the body which is incredibly dangerous and stubborn to treat, resulting in rapid drastic measures.

Thanks for the warning, which I've passed on to DH. He's not a drama queen about his aches and pains, which is generally a good trait, but now I shudder at how long it took for him to even mention it to me, let alone seek treatment. We'll know better next time!

 

[athena53]

Update: all is well. I finally got a human to look into it after faxing her two of the bills that concerned me. (Same day, same treatment code, one for $225 and one for $670).


They do have an affiliate in FL and they use the same billing vendor, which explains why the FL header. Subsequent bills have been on the local hospital's header only. The difference between the two bills is that $670 is the hospital's facility charges and the $225 is the physician's charges. She showed me where to find it in the "Provider Street Address" box on the Medicare claim documents I'd sent. One showed the doctor's name, one showed the hospital name.


I'm still glad I persisted. It's good for them to know someone is actually drilling into the detail behind their cryptic bills.