美国国家公共电台 NPR--The case of the two Grace Elliotts: a medical bill mystery

The case of the two Grace Elliotts: a medical bill mystery

Transcript¹

Earlier this year, Grace Elizabeth Elliott got a mysterious hospital bill for medical care she had never received.

She soon discovered how far a clerical error can reach — even across a continent — and how frustrating² it can be to fix.

During a college break in 2013, Elliott, then 22, began to feel faint and feverish³ while visiting her parents in Venice, Fla., which is about an hour south of Tampa. Her mother, a nurse, drove her to a facility that locals knew simply as Venice Hospital.

In the emergency department, Elliott was diagnosed with a kidney infection and held overnight before being discharged with a prescription⁴ for antibiotics⁵, a common treatment for the illness.

"My hospital bill was about $100, which I remember because that was a lot of money for me as an undergrad," said Elliott, now 31.

She recovered and eventually moved to California to teach preschool. Venice Regional Medical Center was bought by Community Health Systems, based in Franklin, Tenn., in 2014 and eventually renamed ShorePoint Health Venice.

The kidney infection and overnight stay in the E.R. would have been little more than a memory for Elliott.

Then another bill came.

The Patients: Grace E. Elliott, 31, a preschool teacher living with her husband in San Francisco, and Grace A. Elliott, 81, a retiree in Venice, Fla.

Medical Services: For Grace E., an emergency department visit and overnight stay, plus antibiotics to treat a kidney infection in 2013. For Grace A., a shoulder replacement⁷ and rehabilitation⁸ services in 2021.

Service Provider: Venice Regional Medical Center, later renamed ShorePoint Health Venice.

Total Bill: $1,170, the patient's responsibility for shoulder replacement services, after adjustments and payments of $13,210.21 by a health plan with no connection to Grace E. Elliott. The initial charges were $123,854.14.

What Gives: This is a case of mistaken identity, a billing mystery that started at a hospital registration⁹ desk and didn't end until months after the file had been handed over to a collections agency.

Early this year, Grace E. Elliott's mother opened a bill from ShorePoint Health Venice that was addressed to her daughter and sought more than $1,000 for recent hospital services, Elliott said. She "immediately knew something was wrong."

Months of sleuthing eventually revealed that the bill was meant for Grace Ann Elliott, a much older woman who underwent a shoulder replacement procedure and rehabilitation services at the Venice hospital last year.

Experts said that accessing the wrong patient's file because of a name mix-up is a common error — but one for which safeguards, like checking a patient's photo identification, usually exist.

The hospital had treated at least two Grace Elliotts. When Grace A. Elliott showed up for her shoulder replacement, a hospital employee had pulled up Grace E. Elliott's account by mistake.

"This is the kind of thing that can definitely happen," said Shannon Hartsfield, a Florida attorney who specializes in health care privacy violations¹⁰. (Hartsfield does not represent anyone involved in this case.) "All kinds of human errors happen. A worker can pull up the names, click the wrong button, and then not check [the current patient's] date of birth to confirm."

It was a seemingly obvious error: The younger Elliott was billed for a procedure she didn't have by a hospital she had not visited in years. But it took her nearly a year of hours-long phone calls to undo¹¹ the damage.

At first, worried that she had been the victim of identity theft, Grace E. Elliott contacted ShorePoint Health Venice and was bounced from one department to another. At one point, a billing employee disclosed to Elliott the birthdate the hospital had on file for the patient who had the shoulder replacement — it was not hers. Elliott then sent the hospital a copy of her ID.

It took weeks for an administrator¹² at ShorePoint's corporate¹³ office in Florida to admit the hospital's error and promise to correct it.

In August, though, Grace E. Elliott received a notice that the corporate office had sold the debt to a collections agency called Medical Data Systems. Even though the hospital had acknowledged its error, the agency was coming after Grace E. Elliott for the balance due for Grace A. Elliott's shoulder surgery.

"I thought, 'Well, I'll just work with them directly,'" Grace E. Elliott said.

Her appeal was denied. Medical Data Systems said in its denial letter that it had contacted the hospital and confirmed the name and address on file. The agency also included a copy of Grace A. Elliott's expired driver license¹⁴ to Grace E. — along with several pages of the older woman's medical information — in support of its conclusion.

"A collection agency, as a business associate of a hospital, has an obligation to ensure that the wrong patient's information is not shared," Hartsfield said.

In an email to KHN, Cheryl Spanier, a vice⁶ president of the collections agency wrote that "MDS follows all state and federal rules and regulations." Spanier declined to comment on Elliott's case, saying she needed the written consent of both the health system and the patient to do so.

Elliott's second appeal was also denied. She was told to contact the hospital to clear up the issue. But because the health system had long since sold the debt, Elliott said, she got no traction¹⁵ in trying to get ShorePoint Health Venice to help her. The hospital closed in September.

Resolution: In mid-November, shortly after a reporter contacted ShorePoint Health, which operates other hospitals and facilities in Florida, Grace E. Elliott received a call from Stanley Padfield, the Venice hospital's outgoing privacy officer and director of health information management. "He said, 'It's taken care of,' " Elliott said, adding that she was relieved but skeptical¹⁶. "I've heard that over and over."

Elliott said Padfield told her that she had become listed as Grace A. Elliott's guarantor, meaning she was legally responsible for the debt of a woman she had never met.

Elliott soon received a letter from Padfield stating that ShorePoint Health had removed her information from Grace A. Elliott's account and confirmed that she had not been reported to any credit agencies. The letter said her information had been removed from the collection agency's database and acknowledged that the hospital's fix initially¹⁷ "was not appropriately communicated" to collections.

Padfield said the error started with a "registration clerk," who he said had "received additional privacy education as a result of this incident."

Devyn Brazelton, marketing¹⁸ coordinator¹⁹ for ShorePoint Health, told KHN the hospital believes the error was "an isolated²⁰ incident."

Using the date of birth provided by a hospital worker, Elliott was able to contact Grace A. Elliott and explain the mix-up.

"I'm a little upset right now," Grace A. Elliott told KHN on the day she learned about the billing error and disclosure of her medical information.

The Takeaway: Grace E. Elliott said that when she asked Padfield, the Venice hospital's outgoing privacy officer, whether she could have done something to fight such an obvious case of mistaken identity, he replied, "Probably not."

This, experts said, is the dark secret of identity issues: Once a mistake has been entered into a database, it can be remarkably²¹ difficult to fix. And such incorrect information can live for generations.

For patients, that means it's crucial to periodically review the information on your patient portal — the online medical profile many providers use to manage things like scheduling appointments, organizing medical records, and answering patient questions.

One downside of electronic medical records is that errors spread easily and repeat frequently. It is important to challenge and correct errors in medical records early and forcefully, with every bit of documentation available. That is true whether the problem is an incorrect name, a medication no longer (or never) taken, or an inaccurate²² diagnosis²³.

The process of amending²⁴ a record can be "very involved," Hartsfield said. "But with patients able now to see more and more of their medical records, they are going to want those amendments²⁵, and health systems and their related entities²⁶ need to get prepared for that."

Grace A. Elliott told KHN that she had received a call from ShorePoint Health in the previous few months indicating that she owed money for her shoulder replacement.

She asked for a copy of the bill, she told KHN. Months after she asked, it still hadn't arrived.

1 transcript   

n.抄本，誊本，副本，肄业证书

参考例句：

• A transcript of the tapes was presented as evidence in court.一份录音带的文字本作为证据被呈交法庭。
• They wouldn't let me have a transcript of the interview.他们拒绝给我一份采访的文字整理稿。

2 frustrating   

adj.产生挫折的，使人沮丧的，令人泄气的v.使不成功( frustrate的现在分词 )；挫败；使受挫折；令人沮丧

参考例句：

• It's frustrating to have to wait so long. 要等这么长时间，真令人懊恼。
• It was a demeaning and ultimately frustrating experience. 那是一次有失颜面并且令人沮丧至极的经历。 来自《简明英汉词典》

3 feverish   

adj.发烧的，狂热的，兴奋的

参考例句：

• He is too feverish to rest.他兴奋得安静不下来。
• They worked with feverish haste to finish the job.为了完成此事他们以狂热的速度工作着。

4 prescription   

n.处方，开药；指示，规定

参考例句：

• The physician made a prescription against sea- sickness for him.医生给他开了个治晕船的药方。
• The drug is available on prescription only.这种药只能凭处方购买。

5 antibiotics   

n.（用作复数）抗生素；（用作单数）抗生物质的研究；抗生素，抗菌素( antibiotic的名词复数 )

参考例句：

• the discovery of antibiotics in the 20th century 20世纪抗生素的发现
• The doctor gave me a prescription for antibiotics. 医生给我开了抗生素。

6 vice   

n.坏事；恶习；[pl.]台钳，老虎钳；adj.副的

参考例句：

• He guarded himself against vice.他避免染上坏习惯。
• They are sunk in the depth of vice.他们堕入了罪恶的深渊。

7 replacement   

n.取代，替换，交换；替代品，代用品

参考例句：

• We are hard put to find a replacement for our assistant.我们很难找到一个人来代替我们的助手。
• They put all the students through the replacement examination.他们让所有的学生参加分班考试。

8 rehabilitation   

n.康复，悔过自新，修复，复兴，复职，复位

参考例句：

• He's booked himself into a rehabilitation clinic.他自己联系了一家康复诊所。
• No one can really make me rehabilitation of injuries.已经没有人可以真正令我的伤康复了。

9 registration   

n.登记，注册，挂号

参考例句：

• Marriage without registration is not recognized by law.法律不承认未登记的婚姻。
• What's your registration number?你挂的是几号？

10 violations   

违反( violation的名词复数 )； 冒犯； 违反（行为、事例）； 强奸

参考例句：

• This is one of the commonest traffic violations. 这是常见的违反交通规则之例。
• These violations of the code must cease forthwith. 这些违犯法规的行为必须立即停止。

11 undo   

vt.解开，松开；取消，撤销

参考例句：

• His pride will undo him some day.他的傲慢总有一天会毁了他。
• I managed secretly to undo a corner of the parcel.我悄悄地设法解开了包裹的一角。

12 administrator   

n.经营管理者，行政官员

参考例句：

• The role of administrator absorbed much of Ben's energy.行政职务耗掉本很多精力。
• He has proved himself capable as administrator.他表现出管理才能。

13 corporate   

adj.共同的，全体的；公司的，企业的

参考例句：

• This is our corporate responsibility.这是我们共同的责任。
• His corporate's life will be as short as a rabbit's tail.他的公司的寿命是兔子尾巴长不了。

14 license   

n.执照，许可证，特许；v.许可，特许

参考例句：

• The foreign guest has a license on the person.这个外国客人随身携带执照。
• The driver was arrested for having false license plates on his car.司机由于使用假车牌而被捕。

15 traction   

n.牵引；附着摩擦力

参考例句：

• I'll show you how the traction is applied.我会让你看如何做这种牵引。
• She's injured her back and is in traction for a month.她背部受伤，正在作一个月的牵引治疗。

16 skeptical   

adj.怀疑的，多疑的

参考例句：

• Others here are more skeptical about the chances for justice being done.这里的其他人更为怀疑正义能否得到伸张。
• Her look was skeptical and resigned.她的表情是将信将疑而又无可奈何。

17 initially   

adv.最初，开始

参考例句：

• The ban was initially opposed by the US.这一禁令首先遭到美国的反对。
• Feathers initially developed from insect scales.羽毛最初由昆虫的翅瓣演化而来。

18 marketing   

n.行销，在市场的买卖，买东西

参考例句：

• They are developing marketing network.他们正在发展销售网络。
• He often goes marketing.他经常去市场做生意。

19 coordinator   

n.协调人

参考例句：

• The UN Office for the Coordination of Humanitarian Affairs, headed by the Emergency Relief Coordinator, coordinates all UN emergency relief. 联合国人道主义事务协调厅在紧急救济协调员领导下，负责协调联合国的所有紧急救济工作。
• How am I supposed to find the client-relations coordinator? 我怎么才能找到客户关系协调员的办公室？

20 isolated   

adj.与世隔绝的

参考例句：

• His bad behaviour was just an isolated incident. 他的不良行为只是个别事件。
• Patients with the disease should be isolated. 这种病的患者应予以隔离。

21 remarkably   

ad.不同寻常地，相当地

参考例句：

• I thought she was remarkably restrained in the circumstances. 我认为她在那种情况下非常克制。
• He made a remarkably swift recovery. 他康复得相当快。

22 inaccurate   

adj.错误的，不正确的，不准确的

参考例句：

• The book is both inaccurate and exaggerated.这本书不但不准确，而且夸大其词。
• She never knows the right time because her watch is inaccurate.她从来不知道准确的时间因为她的表不准。

23 diagnosis   

n.诊断，诊断结果，调查分析，判断

参考例句：

• His symptoms gave no obvious pointer to a possible diagnosis.他的症状无法作出明确的诊断。
• The engineer made a complete diagnosis of the bridge's collapse.工程师对桥的倒塌做一次彻底的调查分析。

24 amending   

改良，修改，修订( amend的现在分词 )； 改良，修改，修订( amend的第三人称单数 )( amends的现在分词 )

参考例句：

• Amending acts in 1933,1934, and 1935 attempted to help honest debtors rehabilitate themselves. 一九三三年，一九三四年和一九三五年通过的修正案是为了帮助诚实的债务人恢复自己的地位。
• Two ways were used about the error-amending of contour curve. 采用两种方法对凸轮轮廓曲线进行了修正。

25 amendments   

（法律、文件的）改动( amendment的名词复数 )； 修正案； 修改； （美国宪法的）修正案

参考例句：

• The committee does not adequately consult others when drafting amendments. 委员会在起草修正案时没有充分征求他人的意见。
• Please propose amendments and addenda to the first draft of the document. 请对这个文件的初稿提出修改和补充意见。

26 entities   

实体对像； 实体，独立存在体，实际存在物( entity的名词复数 )

参考例句：

• Our newspaper and our printing business form separate corporate entities. 我们的报纸和印刷业形成相对独立的企业实体。
• The North American continent is made up of three great structural entities. 北美大陆是由三个构造单元组成的。