A police officer was injured in the line of duty resulting in a severe open fracture of the calcaneus (heel bone). The police officer was taken to the ER and admitted for treatment. This resulted in a 20-day hospitalization that included multiple surgeries to clean up the wound, repair the fracture and do skin grafts to reconstruct the foot. When all was said and done, the bill for this service totaled $761,464.
Upon review of the bill, WellRithms discovered it was fraught with numerous inflated and disallowable charges particularly with the dressing supplies used before and after the surgery. For example, WellRithms noted ten boxes of 4” x 4” gauze pads, which cost $0.90 per box, were charged at $21,220. This charge appeared on the bill three times. In total, the facility charged over $60,000 for gauze pads alone.
Furthermore, WellRithms found that a particular implant for the foot repair was billed at $3,645 while there was no documentation (in any of the multiple operative reports) that it was ever used. An expensive irrigation device, which is used to clean wounds, was charged twice on this bill, each at $8,317. Typically, this irrigation device is never reimbursed under any circumstances. Additionally, there was a charge for plaster casting material that usually costs $0.40 for ten strips. The itemized bill indicated that they used ten strips and yet they charged $3,440. While everyone agrees that marking up prices for inventory is acceptable business practice, no one would buy a single box of Band-Aids at their local pharmacy if they were marked up by 8,600%.
The facility billed the police force, a public entity, $761,464. WellRithms recommended a payment of $187,781 which resulted in $573,682 savings to the police force. That’s over half of a million taxpayer dollars in savings!
The facility filed a complaint to WellRithms regarding their reimbursement recommendation. However, the initial hospital complaint was countered with WellRithms’ detailed, line-by-line bill review revealing the particularly egregious charges for supplies, implants, and surgical fees. The facility decided it would not be in their best interest to fight the review, which would expose their billing practices on public record, and accepted WellRithms’ recommended payment with no further pushback.