War Stories from the Medical Billing Advocate Battlefield

by Sheri Samotin

Today was a very interesting session at the Medical Billing Adovcates of America's (www.billingadvocates.com) annual workshop. We spent the day hearing interesting speakers from the Florida Attorney General's office talk about fraud and abuse as it applies to medical billing. We also spent time with an attorney who specializes in helping patients fight with their insurance plans and providers.

There seems to be no end to the tactics that providers, especially hospitals, will go to in order to capture extra dollars from payors and patients. They will try to charge for the drapes and gowns in the operating room, even though they are already being paid for the use of the OR and are supposed to include (or "bundle") those items into the facility fee. Or, I'm sure you've heard the one about the "infection control device" charge for $17.44 that was actually a box of tissues. I can tell you that spending the day with more than thirty medical billing advocates reinforces my belief that the profession we are in is absolutely critical to any chance of meaningful health care reform!

I'm especially proud when I hear from colleagues about the many thousands of dollars they have saved patients. The really nice part, is that so often, in the process of helping their clients, they are also saving "the system" money either directly or by uncovering sytematic fraud that can then be reported to the appropriate authorities. As we learned today, once a reporr has been filed, the state has the responsibility to investigate and if they find sufficient evidence, they will pursue civil, and sometimes criminal, action against those conducting the fraudulent activity.

While your medical billing advocate is typically not an attorney and can't provide you with legal advice, we can identify the errors and sometimes outright fraud that is found on an estimated 90% of provider bills. And once we find these things, we will work on your behalf to get them fixed so that you only pay what you really owe. From time to time, we will hit a brick wall and advise you to consult with an attorney who specializes in these matters.


Sheri L. Samotin, President of LifeBridge Solutions, is a member of the Aging with Grace "Ask an Expert" program. With more than 25 years of business and management experience LifeBridge Solutions provides the necessary expertise and skills to help people with Insurance claims advocacy and daily money management.