We uncovered some unbelievable medical billing errors in the case of a police officer who was injured in the line of duty.
With a severe open fracture of the calcaneus (heel bone), the officer was admitted to the hospital for a 20-day stay, multiple surgeries, and skin grafts to reconstruct the foot. The final bill? A staggering $761,464.26.
Upon review, WellRithms discovered numerous inflated and disallowable charges, particularly with the dressing supplies used before and after the surgery. For example, we found a particular implant for the foot repair was billed at $3,645 despite there being no documentation it was ever used and an expensive irrigation device, which is typically never reimbursed, was charged twice on the bill, each at $8,317.
The real shocker was discovering the facility charged $21,220 for ten boxes of gauze pads that cost $0.90 per box. This charge appeared on the bill three times, totaling over $60,000 for gauze pads alone.
In total, WellRithms recommended a payment of $187,781.52, resulting in savings of $573,682.74 for the police force and taxpayers. That's over half a million dollars in savings!
The facility filed a complaint to WellRithms regarding our reimbursement recommendation, but our detailed, itemized bill review revealed their particularly egregious charges for supplies, implants, and surgical fees. The facility decided to accept our recommended payment with no further pushback, rather than fight the review and expose their billing practices on public record.