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Posted on: 2/27/14 9:32 PM ET
I've been fighting over fraudulent billing practices at a mega medical/hospital chain in NYC with no results. They are now threatening me with collections. They shuffle money around. They bill incorrectly. They 'lose' my payments even though they've cashed my checks and given me receipts.
I've never seen anything like it. At first I thought I was dealing with inept people. But its obviously fraud. I don't know who to go to. I'm still unemployed. Its not like I can afford a lawyer.
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I've never seen anything like it. At first I thought I was dealing with inept people. But its obviously fraud. I don't know who to go to. I'm still unemployed. Its not like I can afford a lawyer.
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Ana, the ripper
Posted on: 2/27/14 10:03 PM ET
In reply to anae
I'm not sure I'd do this myself, but if you have all the bills, dates, cancelled checks, etc. I'm wondering if your local TV station would like to take this story on. It might get the mega medical/hospital chain's attention very quickly. You're probably not the only one having this problem.
What about an attorney from Legal Aid in NY?
What a hassle. I'm sort of going through something similar but going to collections isn't an issue. It seems they will not directly answer my questions.......they just change the subject to something which isn't the problem. Grrrr
What about an attorney from Legal Aid in NY?
What a hassle. I'm sort of going through something similar but going to collections isn't an issue. It seems they will not directly answer my questions.......they just change the subject to something which isn't the problem. Grrrr
Posted on: 2/27/14 10:18 PM ET
contact your state's attorney generals office
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My grandmother taught me to sew when I was 10, and I've been sewing ever since.
Posted on: 2/27/14 10:22 PM ET
In reply to diane s
Good recommendation. I was thinking the same but forgot to post it. Glad you did.
Posted on: 2/28/14 1:33 AM ET
In reply to anae
I've been a medical biller for a large medical/hospital before- a long time ago, not that one though. Some things to look for (when you try to reconcile everything on your paper work, on your side) that might have happened and maybe by mistake and not particular fraud at all:
When you say "shuffle money around" do you mean there are different departments and billing agencies for Hospital and room fees v.s Physicians charges, in the same place or building and money you thought or you ment to be paying and applied to one, got applied to the other? I think that might be pretty common, if you paid at a desk inside someplace like that, sometimes.
But still, no matter what, all money you ever paid for anything, should all show up paper trail wise and audit trail wise, and should still always add up to all money shown as paid, on your statements, someplace from someone, just no matter what too.
You might need to tell them, someone needs to sit down and spend a lot of time, personally and humanly, reconciling, on a real paper spreadsheet your whole account, with those copies of the cancelled checks that you would give them. Sorry to say. But they most times have some people there that can do that. And should.
If they "loose your checks" after they have cashed them, or they show up nowhere, on your bills and statements, and you can prove that even by the bank stamping on the back of your cancelled checks, (which you might need to get from your bank if they don't normally give those back to you anymore) that they cashed them which would show on the stamping on the back of a check, and even where they went to, and the date of it and their bank also, then tough for them, as you got proof of payment.
It's their problem then, to find out where it got... miss-applied to! And then to re-apply it back to where it should go! Also look at the face of your cancelled checks too, as something encoded or scribbled on there, might indicate where the money went to there. As in account #'s that are not yours, or another department or something like that.
It does not matter if they miss-applied your check to someone else's account at all even then, as long as you can prove by the cancelled check they got the money- that's it. But if you give them a copy of the cancelled checks, (not your real ones) for proof, sometimes if they even just see it, it makes it much more easy and quick for them to tell, where it might have got miss applied to even. So that might be a possibility.
Have also been the person, that goes and sits with people in the little booth by appointment before, that try's to figure all that out... not a fun job at all and I did used to really dread that sometimes, but they should have some people there that are willing to do that for you too Not just keep on sending you the same billings over and over again. But I think you need to say, "Reconcile my Account! "
All this is not for fraud at all though, that would be something very different. I did not ever see that going on where I was at all. There could be some inept people, there could also just be some way overworked people or not enough people working doing that, there could be some computer systems with flaws and glitches in them, there could be just anything actually.
But I have been on both sides of this thing, multiple times, just since had to reconcile a lot of neighbors and relatives medical billings for them too, so if you know anyone like that, go find them and try to get them to take a look at all of it too. A new and different set of eyeballs looking at something, is way better than just one!
They might even have some patient advocate group or department there someplace that could help you too, or if you belong to some other organization- in case you were a senior citizen or such and belonged to some senior recreation center or such, as I know some places like that can often have that kind of service or thing going on to sometimes.
As to actual real fraud, don't know what to advise, but maybe someone else will.
When you say "shuffle money around" do you mean there are different departments and billing agencies for Hospital and room fees v.s Physicians charges, in the same place or building and money you thought or you ment to be paying and applied to one, got applied to the other? I think that might be pretty common, if you paid at a desk inside someplace like that, sometimes.
But still, no matter what, all money you ever paid for anything, should all show up paper trail wise and audit trail wise, and should still always add up to all money shown as paid, on your statements, someplace from someone, just no matter what too.
You might need to tell them, someone needs to sit down and spend a lot of time, personally and humanly, reconciling, on a real paper spreadsheet your whole account, with those copies of the cancelled checks that you would give them. Sorry to say. But they most times have some people there that can do that. And should.
If they "loose your checks" after they have cashed them, or they show up nowhere, on your bills and statements, and you can prove that even by the bank stamping on the back of your cancelled checks, (which you might need to get from your bank if they don't normally give those back to you anymore) that they cashed them which would show on the stamping on the back of a check, and even where they went to, and the date of it and their bank also, then tough for them, as you got proof of payment.
It's their problem then, to find out where it got... miss-applied to! And then to re-apply it back to where it should go! Also look at the face of your cancelled checks too, as something encoded or scribbled on there, might indicate where the money went to there. As in account #'s that are not yours, or another department or something like that.
It does not matter if they miss-applied your check to someone else's account at all even then, as long as you can prove by the cancelled check they got the money- that's it. But if you give them a copy of the cancelled checks, (not your real ones) for proof, sometimes if they even just see it, it makes it much more easy and quick for them to tell, where it might have got miss applied to even. So that might be a possibility.
Have also been the person, that goes and sits with people in the little booth by appointment before, that try's to figure all that out... not a fun job at all and I did used to really dread that sometimes, but they should have some people there that are willing to do that for you too Not just keep on sending you the same billings over and over again. But I think you need to say, "Reconcile my Account! "
All this is not for fraud at all though, that would be something very different. I did not ever see that going on where I was at all. There could be some inept people, there could also just be some way overworked people or not enough people working doing that, there could be some computer systems with flaws and glitches in them, there could be just anything actually.
But I have been on both sides of this thing, multiple times, just since had to reconcile a lot of neighbors and relatives medical billings for them too, so if you know anyone like that, go find them and try to get them to take a look at all of it too. A new and different set of eyeballs looking at something, is way better than just one!
They might even have some patient advocate group or department there someplace that could help you too, or if you belong to some other organization- in case you were a senior citizen or such and belonged to some senior recreation center or such, as I know some places like that can often have that kind of service or thing going on to sometimes.
As to actual real fraud, don't know what to advise, but maybe someone else will.
Posted on: 2/28/14 2:50 AM ET
In reply to anae
Quote: anae
They shuffle money around. They bill incorrectly. They 'lose' my payments even though they've cashed my checks and given me receipts.
They shuffle money around. They bill incorrectly. They 'lose' my payments even though they've cashed my checks and given me receipts.
How far up in the billing dept have you reported these problems? Maybe there is embezzlement going on that needs to be investigated by a dept head at the main office.
Otherwise, as it's already been mentioned either contact a local TV station's problem solvers team or your state's Attorney General.
Be sure to keep your original receipts and cashed checks as safe as gold. Only give out copies...even to the billing dept staff.
Sorry you are going through this.

Edited to add: beauturbo gave good advice from the perspective of having worked in such a dept. I never thought about having an individual reconciliation appointment. Again...very sorry you are going through this...very stressful.
-- Edited on 2/28/14 3:17 AM --
Posted on: 2/28/14 11:04 AM ET
I worked at a medical institution that was actually charged and fined by the federal government for similar activities. Patient's payments were not applied correctly or not at all, even when proof was provided. Patients were being sent to collection that had 0 balances. Liens were being put on patient properties when there were no balances due..the list goes on and on. The instituion was made to pay millions in fines. I was working in the patient accounts department at this time and I saw negligence that I just could not understand. There were drawers full of patient's unanswered correspondence, copies of cancelled checks etc., that just sat there while we sent hundreds of accounts out to collection daily! When I asked my supervisor if I could go through them and try to match them with accounts to help, he suggested that I resign, as he said it would take too much time and effort, and most patients would not realize that they had overpaid us, or that if they did realize that they did not owe that, most were low-income and would not be able to afford the legal fees to pursue action against the hospital. I did leave eventually, and I saw a short time later that the hospital was being investigated and he had been dismissed.
My advice is to make a person to person appointment with a representative from the hospital and bring copies of all your documentation with you. Send letters, etc., certified and provide a copy to your state attorney general. I would also copy your state insurance commissioner, as there are laws and processes that hospitals and insurance companies have to follow when accepting and applying insurance payments.
I hope that you have a positive resolution to this issue.
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My advice is to make a person to person appointment with a representative from the hospital and bring copies of all your documentation with you. Send letters, etc., certified and provide a copy to your state attorney general. I would also copy your state insurance commissioner, as there are laws and processes that hospitals and insurance companies have to follow when accepting and applying insurance payments.
I hope that you have a positive resolution to this issue.
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Deb: www.thinkingcouture.blogspot.com
Posted on: 2/28/14 11:15 AM ET
In reply to anae
Don't let it slide. Something is at least mixed up, and you deserve to have it all clearly laid out. I think you should be able to get legal aid assistance.
It reminds me of a similar experience, but on a smaller scale. Our doctor's office (a practice with 3 doctors) kept sending bills that seemed like duplicates or just $20 over what they should have been. I couldn't match up the services with the fees. I kept going to the business manager, asking for help, but it just went on and on. It did stop -- when I read in the newspaper that the business manager had been charged with embezzling!
It reminds me of a similar experience, but on a smaller scale. Our doctor's office (a practice with 3 doctors) kept sending bills that seemed like duplicates or just $20 over what they should have been. I couldn't match up the services with the fees. I kept going to the business manager, asking for help, but it just went on and on. It did stop -- when I read in the newspaper that the business manager had been charged with embezzling!
Posted on: 2/28/14 11:51 AM ET
Consider contacting a local legal clinic at a law school. Look into pro bono lawyering opportunities at firms that handle this kinds of stuff. Don't ignore the chance of legal help if you don't have money--some will work on a contingency that they won't get paid unless you win, and they'll take only a certain % of your damages. Even consider talking to your state legislator's office; I worked for one state senator that helped people with problems like this (as well as mostly prop8 stuff) all the time.
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I'll try anything once :)
SM: Pfaff Performance 5.2; Brother LS2125-i; 1929 Singer 99k; 1956 Singer 15-125; Singer SewHandy
Serger: Babylock Acclaim; Janome 7034D
9/1/19: Meowied!
Sewed my veil, and Doggo's bowtie and ring bag.
SM: Pfaff Performance 5.2; Brother LS2125-i; 1929 Singer 99k; 1956 Singer 15-125; Singer SewHandy
Serger: Babylock Acclaim; Janome 7034D
9/1/19: Meowied!
Sewed my veil, and Doggo's bowtie and ring bag.
Posted on: 2/28/14 4:20 PM ET
When I worked as a medical biller at one large institution, (and maybe one of the more respected ones anyplace) there was at first, one large billing system for all charges, in patient and out, professional services (Doctors fee) and room charges and everything). System underwent a change, and split into to separate enitities and billing factions, one for professional fees and one for not. But, after that happened, along with massive computer system and billing changes, there was for a while a "internal fight and conflict" between the two, on some payments that came in, just sort of depending on how payed, as in if a patient actually handed a check to someone behind a counter someplace, where that payment might get applied to- and to which of those two things each time! What a mess!
Money, money, money!!!!!!! Is what makes things go round.
Also, there really were, approved collection agencies that came in hunting for work (accounts) to be assigned to them. To do that, they would check the obituary's in the newspapers, and then check hospital records to see if they could be matched up to any unpaid bills. If they found some, they might "get assignment" on those.
Also, because of my position, I was allowed and it was approved and it was at the time, perfectly fine when submitting billings to Medi-Cal to use a rubber stamp, with my approved name on it, instead of personally signing with ink, my name, on my billings. Nothing wrong with that at all.
But when I left, I was cutting that rubber stamp in half with a pair of shears. At least the rubber part of it. Since it had my name on it. Someone there, took issue with that, and wanted me not to do that, just since they thought a more "temporary employee" that might have to be there after me, might need it for a while until they got their own. (WTF!!!!) That did not sit right with me at all. And no way was that going to be going on, I cut it in half, just anyways!
Medical Billing is fraught with all sorts of things that can happen, and is something that has to really be kept on top of at all times, on all levels, and you need a huge and competent work force, all working together in the just the right way, to make that kind of thing stay working smooth and not a huge mess.
So, yes I think everyone should really check and reconcile all their medical bills themselves real good too, just since it's sort of fraught with all those kind of perils even.
I think it would be pretty hard most times for any one bad, rouge employee though, to steal patient checks,and somehow devirt them, out of the system, and into their own bank accounts, (with out altering the actual paper checks first) and not the medical institution's one. and even be an embezzler like that. As all sorts of check and balances for things like that. And the actual cancelled check and the bank coding on back of it, would be the audit trail for something like that even. But, if for some reason (by your real cancelled checks when you look at them) you think that could be happening, speak up quick, go find all your cancelled checks, go right down there in person and even make a big huge deal of it!!!!! Right away too!
-- Edited on 2/28/14 4:41 PM --
Money, money, money!!!!!!! Is what makes things go round.
Also, there really were, approved collection agencies that came in hunting for work (accounts) to be assigned to them. To do that, they would check the obituary's in the newspapers, and then check hospital records to see if they could be matched up to any unpaid bills. If they found some, they might "get assignment" on those.
Also, because of my position, I was allowed and it was approved and it was at the time, perfectly fine when submitting billings to Medi-Cal to use a rubber stamp, with my approved name on it, instead of personally signing with ink, my name, on my billings. Nothing wrong with that at all.
But when I left, I was cutting that rubber stamp in half with a pair of shears. At least the rubber part of it. Since it had my name on it. Someone there, took issue with that, and wanted me not to do that, just since they thought a more "temporary employee" that might have to be there after me, might need it for a while until they got their own. (WTF!!!!) That did not sit right with me at all. And no way was that going to be going on, I cut it in half, just anyways!
Medical Billing is fraught with all sorts of things that can happen, and is something that has to really be kept on top of at all times, on all levels, and you need a huge and competent work force, all working together in the just the right way, to make that kind of thing stay working smooth and not a huge mess.
So, yes I think everyone should really check and reconcile all their medical bills themselves real good too, just since it's sort of fraught with all those kind of perils even.
I think it would be pretty hard most times for any one bad, rouge employee though, to steal patient checks,and somehow devirt them, out of the system, and into their own bank accounts, (with out altering the actual paper checks first) and not the medical institution's one. and even be an embezzler like that. As all sorts of check and balances for things like that. And the actual cancelled check and the bank coding on back of it, would be the audit trail for something like that even. But, if for some reason (by your real cancelled checks when you look at them) you think that could be happening, speak up quick, go find all your cancelled checks, go right down there in person and even make a big huge deal of it!!!!! Right away too!
-- Edited on 2/28/14 4:41 PM --
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