A workers’ compensation outpatient hospital bill we reviewed involving a 53-year-old security guard in Scottsdale, Ariz. who required back surgery was riddled with examples of egregious medical overbilling.
Our advanced medical bill review technology, coupled with a repricing strategy rooted in the expertise of physicians and surgeons who understand the medicine behind these bills, removed these charges with surgical precision.
An Anatomy of Overcharging
Inflated charges totaling $114,086 were spread across the operating room, overpriced extended recovery, anesthesia, and other areas. We repriced the claim at $12,059, just under 11% of billed charges, including all medications, supplies, labs, physical therapy, and surgery costs for this facility.
The patient had a condition that occurs when the spinal column narrows over time and puts pressure on the nerve roots, making it difficult to walk. He also had a rare but serious disorder that applies pressure at the end of the spinal cord.
The most shocking charges involved surgery on the lower end of the patient’s spine. Each procedure was billed at $40,538 for what should have been no more than two hours in the operating room. The bills were rounded out with $33,009 in other charges that included $13,000 in outpatient treatment for an extended stay in the recovery room over two days – about 10 times the cost of a hospital bed.
One interesting side note is that loosened hardware was removed from a previous spine surgery in early 2023 to repair a spine fracture caused by a car crash.
Miscellaneous hospital charges featured four lab tests that were processed, about an hour of physical therapy services that included evaluation, multiple drugs or injections, other medical supplies, and an electrocardiogram.
When unpacking those we discovered a $950 charge for 13 grams of a common antibiotic given during and after surgery to prevent infection – an amount that is extremely unlikely to have been needed and would have cost no more than $30.
Other examples of overbilling include a steroid injection billed at $240 that should have cost just $3, a $185 charge for $1.20 worth of fentanyl, and $338 for $1.82 worth of IV fluids that were not even a separate billable charge and therefore were removed from the bill.
While some of these inflated charges are minimal compared to the sum total of expenses, they are part of a troubling pattern of overbilling that shows no sign of slowing down. For more information on how WellRithms can get you results, contact info@wellrithms.com.