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‘Don’t be afraid to ask for itemized bills’
Patients checking out of the hospital or their healthcare provider should not be afraid to ask for an itemized bill as that is one way to avoid fraudulent billings, according to Federal Bureau of Investigation Special Agent Jamie Prida.
Speaking to members of the Rotary Club of Saipan during their regular meeting yesterday at the Hyatt Regency Saipan, Prida recounted FBI investigations into fraudulent billings from hospitals and other healthcare providers in the U.S. mainland.
One example is a case at a big hospital in Texas where Prida and another FBI agent recovered $50 million for services that were never rendered and cost reports that should not have been made.
He also said that he investigated three private physicians in the billing for services that were not rendered or needed.
“The three doctors ended up going to federal prison,” he said.
Other examples of fraud that he has investigated involved ambulance companies, durable medical equipment, and home health agencies.
He said that billings cannot only be done by hospitals as “it is the hospital’s choice to chose an outside billing company.”
He said that based on his experience, fraudulent billings are rampant in the U.S. mainland. “Hard hitters were Florida, Texas, California, and New York.”
In Texas alone, he said, the money involved equaled trillions of dollars.
A Rotary member asked him if this form of fraudulent billing happens in the CNMI and, if so, how much money is involved. Prida replied: “We don’t have any information yet but we know it’s happening.”
He said that hospitals have to give an itemized billing if requested because it’s the law and that every bill from hospitals should have Current Procedure Terminology that tells the codes of what the billing is about.
Since Saipan has no branch of the U.S. Department of Health and Human Services, people with any information or complaint about their hospital or healthcare provider billings can go to the FBI office at the Bank of Hawaii building in Garapan.
