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How Do I Resolve a Fraudulent Hospital Bill?

July 25, 2018

We all know that insurance and medical care in the United States is an often shockingly expensive but necessary part of life, but sometimes the cost may be doubly shocking when you are the victim of fraudulent hospital bills that overcharged you for everything. It is quite possible that the billing department inadvertently entered the incorrect code, thus charging a patient for a service they did not receive. However, there have also been countless cases involving patients who were overcharged on purpose in order help the bottom line of the hospital.

Billing fraud happens when a health care provider files a claim and knows that it is incorrect by manipulating coding to their advantage.

Upcoding is one way that providers can inflate the costs of a procedure or visit. By using a code for a more complicated or lengthy procedure, such as coding a common cold visit as a pneumonia visit, a provider can significantly increase how much they are paid.

Unbundling services which are commonly done together is another way that providers can inflate their pay. For example, billing for cleaning a wound, stitching it up, and applying a dressing could be billed using three separate codes rather than one. So-called unbundling is illegal but is something that happens to unsuspecting patients all too often.

Double billing is a seemingly innocuous mistake whereby a bill is submitted multiple times for a procedure that was only performed once.

If you suspect that you’ve received a bill containing fraudulent charges, then what can you do to resolve it? While it is a headache to have to do, fighting these charges could save you hundreds, if not thousands, of dollars.

Your first step to resolving should be to contact the hospital billing department to report any problems or discrepancies. As mentioned, mistakes do happen, so they may be quick to correct any inaccuracies. If they don’t want to help correct an error, you shouldn’t be afraid to request the contact information of the Chief Financial Officer at the hospital, which may rattle the billing employee into taking a closer look.

If you still haven’t received a satisfactory response, you should contact your state’s insurance anti-fraud division. In the state of Texas, you can contact the Texas Department of Insurance, Anti-Fraud Division at (888) 327-8818.

All too often, you must be persistent in order to resolve any fraudulent billing or mistakes since billing departments are not usually that responsive to mistakes that were made in their favor financially.

Upcoding and other forms of fraudulent hospital billing don’t just impact you with a one-time higher bill, they can mess up your medical history, indicating you’ve had more serious medical problems and can make you look like a liability to insurance providers.

If you believe that you’ve been overcharged for a hospital stay or emergency room visit, then it is imperative that you speak with an experienced medical malpractice attorney in Texas, like those at Fears Nachawati. Our team has handled many of these cases and we recognize the telltale signs of exploitative overcharging and fraudulent hospital activity. Don’t let yourself become a victim, you must stand up against this deplorable practice of fraudulent charges and overbilling.

For your free, no obligation legal consultation, please call our team today at (866) 705-7584 or visit one of the offices located throughout the great state of Texas, including in Houston, Dallas, Austin, Fort Worth, and San Antonio.


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