How does my girlfriend prove that these medical charges are not hers?
July 1, 2013 2:50 PM Subscribe
She received a $6000+ bill from Kaiser Permanente for a visit to an emergency room which she never made. We suspect identity theft, and Kaiser does not believe her. How can she prove her case, or otherwise get Kaiser to drop their bill?
In late May she received a bill from Kaiser for over $5000 for an emergency room visit from April 7th that she never made. She hasn't had Kaiser insurance in 5 years, although the charge does seem to be on her actual, closed account. Since then she filed a police report and challenged the charge via Kaiser's official byzantine channels. Today she got a letter saying her "request to waive the fees" was denied, that the fees total over $6000, and that the manager confirmed that it was her by photo ID. She was not in Richmond on that date, and she hasn't lost her ID.
In late May she received a bill from Kaiser for over $5000 for an emergency room visit from April 7th that she never made. She hasn't had Kaiser insurance in 5 years, although the charge does seem to be on her actual, closed account. Since then she filed a police report and challenged the charge via Kaiser's official byzantine channels. Today she got a letter saying her "request to waive the fees" was denied, that the fees total over $6000, and that the manager confirmed that it was her by photo ID. She was not in Richmond on that date, and she hasn't lost her ID.
- The emergency room is in Richmond, we live in San Francisco.
- I was probably the only one with her that night, and I believe we stayed home and watched Game of Thrones.
- The bill says that the visit included an ultra-sound, and we are going to work on finding out what the rest of the services were.
- Her credit report is fine.
This is the sort of thing I'd be willing to pay a lawyer to write a letter for me - here are the particulars and dates, refer to the police report, and ask them to stop contacting you about this fraudulent charge.
posted by jquinby at 3:05 PM on July 1, 2013 [1 favorite]
posted by jquinby at 3:05 PM on July 1, 2013 [1 favorite]
I have to believe that Kaiser has surveillance cameras everywhere...can you try to obtain video from that night? They must have a timeline of the time this person checked in, got admitted, was administered tests, etc.
posted by AlliKat75 at 3:06 PM on July 1, 2013
posted by AlliKat75 at 3:06 PM on July 1, 2013
Find any evidence of the account being closed; if it was tied to a previous job (or current job but they changed providers, etc.) then get some info from HR at the relevant employer.
The medical record of the visit would have also captured some biometric data about the patient which may not match your girlfriend; she can deliberately change her weight, but she'd have a harder time changing her height as measured by a medical professional such as a nurse, and they usually require the removal of shoes, straightening of backs, etc. For all you know, the weight could be radically different; suppose the patient is twice or half her weight? It would be difficult to lose or gain that much in 3 months.
KP won't release such data to you-- that would be wrong, but they can compare data you give them (perhaps via a mutually trusted third-party of the medical persuasion).
However, don't expect KP to carry any water on this; they want to get someone to pay, and hardly care if it's the wrong person. Hard evidence would do great in court, but nobody wants this to go to court if it can be avoided.
posted by Sunburnt at 3:06 PM on July 1, 2013
The medical record of the visit would have also captured some biometric data about the patient which may not match your girlfriend; she can deliberately change her weight, but she'd have a harder time changing her height as measured by a medical professional such as a nurse, and they usually require the removal of shoes, straightening of backs, etc. For all you know, the weight could be radically different; suppose the patient is twice or half her weight? It would be difficult to lose or gain that much in 3 months.
KP won't release such data to you-- that would be wrong, but they can compare data you give them (perhaps via a mutually trusted third-party of the medical persuasion).
However, don't expect KP to carry any water on this; they want to get someone to pay, and hardly care if it's the wrong person. Hard evidence would do great in court, but nobody wants this to go to court if it can be avoided.
posted by Sunburnt at 3:06 PM on July 1, 2013
Actually, Kaiser has to release that information to you.
FTC information about medical identity theft. This article doesn't cover what happens when your insurance company refuses to believe that you've been the victim of a crime, but it does cover what kinds of information you can ask the insurance company for.
posted by sciencegeek at 3:11 PM on July 1, 2013 [4 favorites]
FTC information about medical identity theft. This article doesn't cover what happens when your insurance company refuses to believe that you've been the victim of a crime, but it does cover what kinds of information you can ask the insurance company for.
posted by sciencegeek at 3:11 PM on July 1, 2013 [4 favorites]
Definitely go the debt validation route as suggested to start.
KP won't release such data to you-- that would be wrong, but they can compare data you give them (perhaps via a mutually trusted third-party of the medical persuasion).
Actually, under HIPAA, you're entitled to that data if they think it's yours. You'll be waiting around 60 days for it, though. Talk to a lawyer to see if requesting this information under HIPAA constitutes acceptance or acknowledgement of the debt. If not, request all your medical records from this ER under HIPAA.
posted by bfranklin at 3:11 PM on July 1, 2013
KP won't release such data to you-- that would be wrong, but they can compare data you give them (perhaps via a mutually trusted third-party of the medical persuasion).
Actually, under HIPAA, you're entitled to that data if they think it's yours. You'll be waiting around 60 days for it, though. Talk to a lawyer to see if requesting this information under HIPAA constitutes acceptance or acknowledgement of the debt. If not, request all your medical records from this ER under HIPAA.
posted by bfranklin at 3:11 PM on July 1, 2013
Response by poster: deanc, bfranklin: I had looked at debt validation, but since the debt is real, but is falsely attached to my g/f, I thought it might not apply. Thanks for re-suggesting it!
I will talk to my lawyer friends and see what they can come up with for a response letter.
Allikat75: I expect Kaiser to do as little as possible to set this straight. It was a huge battle just to get in touch with the right department that I would doubt they would do that kind of investigative work, even though the evidence is surely there.
Sunburnt: We'll have to find out what data was taken. I know I've been to the KP emergency room and not had any of that data recorded. If we can find out what the ultrasound was for we might find some differentiating info.
sciencegeek: That is the exact webpage I was using to guide me through getting the medical information from Kaiser, thanks for the confirmation.
posted by thetruthisjustalie at 3:28 PM on July 1, 2013 [1 favorite]
I will talk to my lawyer friends and see what they can come up with for a response letter.
Allikat75: I expect Kaiser to do as little as possible to set this straight. It was a huge battle just to get in touch with the right department that I would doubt they would do that kind of investigative work, even though the evidence is surely there.
Sunburnt: We'll have to find out what data was taken. I know I've been to the KP emergency room and not had any of that data recorded. If we can find out what the ultrasound was for we might find some differentiating info.
sciencegeek: That is the exact webpage I was using to guide me through getting the medical information from Kaiser, thanks for the confirmation.
posted by thetruthisjustalie at 3:28 PM on July 1, 2013 [1 favorite]
I may be misunderstanding this but: this is for a charge to a Kaiser account from Kaiser in April, but her health insurance account with Kaiser has been closed for the past five years? How is this even possible? Was the phantom visit to a Kaiser ER (if those exist)?
posted by Keter at 3:34 PM on July 1, 2013
posted by Keter at 3:34 PM on July 1, 2013
The ultrasound must be on file. If it is for a pregnancy, and your gf is not pg, or for any ailment that gf does not have, perhaps your lawyer friends can make Kaiser fess up that they are wrong. Most hospital procedures require signing a consent form. Either there is someone with gf's name, or a forgery. Good Luck.
posted by Cranberry at 3:35 PM on July 1, 2013
posted by Cranberry at 3:35 PM on July 1, 2013
Response by poster: Keter: Yes, from Kaiser to my gf, in the exact name of her account that was closed 5 years ago. It has her middle initial which was different back then. I'm not sure how to identify if it is under a different "account" in Kaiser's records or what, and I don't know if she has her account number from back then.
Cranberry: she's not pregnant, and has never been.
posted by thetruthisjustalie at 3:39 PM on July 1, 2013
Cranberry: she's not pregnant, and has never been.
posted by thetruthisjustalie at 3:39 PM on July 1, 2013
In a similar situation I called the hospital til I got to Billing, and explained the situation. Then I sent along a copy of my medical records which didn't include an ER visit, or any follow up appointments.
I had to have the same conversation like 3 times, but I think being able to say, no for real, you can see I've never broken a bone, it'd be in my medical records, really helped.
And for me it wasn't ID theft -- I just have a common Latino first and last name, lived in a city with a lot of Latinos, and had actually gone to another hospital in the same system for an unrelated issue.
posted by spunweb at 4:00 PM on July 1, 2013
I had to have the same conversation like 3 times, but I think being able to say, no for real, you can see I've never broken a bone, it'd be in my medical records, really helped.
And for me it wasn't ID theft -- I just have a common Latino first and last name, lived in a city with a lot of Latinos, and had actually gone to another hospital in the same system for an unrelated issue.
posted by spunweb at 4:00 PM on July 1, 2013
Response by poster: spunweb: That's great to know. Once we find out what services were rendered and what they were addressing we can make that kind of dispute. The bills just say "Emergency", "ER Visit: Level 4", and "Ultrasound: abdominal, b-scan, limited". Actually the ultrasound is dated Apr 8 - maybe it was a midnight visit.
posted by thetruthisjustalie at 4:10 PM on July 1, 2013
posted by thetruthisjustalie at 4:10 PM on July 1, 2013
I know nothing of the technicalities here, but emergency ultrasounds of the abdomen are also often done diagnostically (let's say a gallbladder ultrasound for abdominal pain). if nothing was found, the reason for the scan may not be as useful (i.e. not being able to prove she never had abdominal pain).
however, if you get a copy of the records, you will probably find a past medical history, surgical history, or family history on the chart that will belong to the identity thief and not your girlfriend. I would imagine that would be helpful evidence to prove your claim. A level 4 visit is a high billing level visit that must have those elements documented to be valid (to be clear, a level 4 chart must have a high level of detail to bill properly).
posted by treehorn+bunny at 4:19 PM on July 1, 2013
however, if you get a copy of the records, you will probably find a past medical history, surgical history, or family history on the chart that will belong to the identity thief and not your girlfriend. I would imagine that would be helpful evidence to prove your claim. A level 4 visit is a high billing level visit that must have those elements documented to be valid (to be clear, a level 4 chart must have a high level of detail to bill properly).
posted by treehorn+bunny at 4:19 PM on July 1, 2013
Best answer: Debt validation as it applies to the FDCPA doesn't apply here since Kaiser is the original creditor; it's a restriction that applied to debt collectors. It wouldn't HURT you to demand it and since you're in the 9th Circus there's (or was) an awful precedent that if you didn't ask for validation within the initial period that you stopped having that right.
(This is something that was in conflict with other circuits when I was last really active in this issue 8+ years ago so it's possible this has been settled by the Supremes by now but you never know)
However you've likely met the metric for this by disputing that it's really you.
Ultrasounds are done for a lot of injuries, it's by no means necessarily a ladybits sort of procedure. Given the above description I'd bet they were looking for internal bleeding though it could be generalized severe abdominal pain. Looks like a billing code description common to medicare:
Abdominal Sonography, limited (e.g., follow-up or limited study) (B-Scan)
That page says this is among items "Category I - (Clinically effective, usually part of initial patient evaluation, may be an adjunct to radiologic and nuclear medicine diagnostic technique)" So that certainly jibes with something done in an emergency room. If it was middle of the night it might have been because they couldn't get a better scan. Or perhaps this was someone doing some drug seeking and they wouldn't take "there's nothing there" for an answer.
Given that Kaiser said something about a request to waive fees I'd bet a dollar that someone miscoded this challenge and didn't send it along the right path for "NOT ME, FUCKER" responses. Or maybe it's standard op to try to discourage nonsense.
Personally I'd send back a certified mail, return receipt requested letter that said, formally, "This is not me. I was not in that area. These are not my charges. I will under no circumstances be paying them. Attached is the police report and incident number." I'd take a page from the debt management playbook and refuse to have any contact with them other than in writing.
Again, original creditor, so you can't legally force them to not contact you by phone. But if you make it clear to them you're not screwing around and don't get drawn into Their Process For Collection then you have a better chance of getting them to just deal with this properly.
posted by phearlez at 4:21 PM on July 1, 2013 [7 favorites]
(This is something that was in conflict with other circuits when I was last really active in this issue 8+ years ago so it's possible this has been settled by the Supremes by now but you never know)
However you've likely met the metric for this by disputing that it's really you.
Ultrasounds are done for a lot of injuries, it's by no means necessarily a ladybits sort of procedure. Given the above description I'd bet they were looking for internal bleeding though it could be generalized severe abdominal pain. Looks like a billing code description common to medicare:
Abdominal Sonography, limited (e.g., follow-up or limited study) (B-Scan)
That page says this is among items "Category I - (Clinically effective, usually part of initial patient evaluation, may be an adjunct to radiologic and nuclear medicine diagnostic technique)" So that certainly jibes with something done in an emergency room. If it was middle of the night it might have been because they couldn't get a better scan. Or perhaps this was someone doing some drug seeking and they wouldn't take "there's nothing there" for an answer.
Given that Kaiser said something about a request to waive fees I'd bet a dollar that someone miscoded this challenge and didn't send it along the right path for "NOT ME, FUCKER" responses. Or maybe it's standard op to try to discourage nonsense.
Personally I'd send back a certified mail, return receipt requested letter that said, formally, "This is not me. I was not in that area. These are not my charges. I will under no circumstances be paying them. Attached is the police report and incident number." I'd take a page from the debt management playbook and refuse to have any contact with them other than in writing.
Again, original creditor, so you can't legally force them to not contact you by phone. But if you make it clear to them you're not screwing around and don't get drawn into Their Process For Collection then you have a better chance of getting them to just deal with this properly.
posted by phearlez at 4:21 PM on July 1, 2013 [7 favorites]
I would only add that if you have a savvy state or federal representative who understands the ins and outs of health care policy, and seems concerned for The People, you could go to them and ask for help.
Couldn't hurt - and if they can do anything about it, that would be awesome.
posted by vitabellosi at 6:26 PM on July 1, 2013 [1 favorite]
Couldn't hurt - and if they can do anything about it, that would be awesome.
posted by vitabellosi at 6:26 PM on July 1, 2013 [1 favorite]
Call the hospital and ask for her medical records for the night in question. If there are no records, and the Med Record department sends her a written statement of that fact, you have additional ammo with which to dispute the charges. If they do send some records, that could give you ammo for proving the identity theft via mismatching information like height, scars, medical history, etc.
Don't request this through billing, and don't tell medical records the real reason why you want the info. Just request and see what turns up.
posted by MultiFaceted at 6:26 PM on July 1, 2013
Don't request this through billing, and don't tell medical records the real reason why you want the info. Just request and see what turns up.
posted by MultiFaceted at 6:26 PM on July 1, 2013
I may be misunderstanding this but: this is for a charge to a Kaiser account from Kaiser in April, but her health insurance account with Kaiser has been closed for the past five years? How is this even possible? Was the phantom visit to a Kaiser ER (if those exist)?
I work for Kaiser. But I am not your Kaiser worker. And this is certainly not Kaiser advice.
An emergency room works under pretty strict guidelines about who they can turn a way and who they can't. Basically, if someone walks in declaring an emergency, he can't be sent away or transferred until he has been examined and declared stable, insurance be damned. So a person could conceivably just walk in off the street and give a false name and address and he would never see the bill. A person can give his old account information, too, and be seen without insurance. So this could absolutely happen in any ER.
I can also see a receptionist pulling up an old patient ID# by putting in the name (same as the GF) and not cross checking the date of birth and address carefully. It's not that hard to end up in the wrong chart.
And yes, Kaiser really does have emergency rooms.
Good luck!
posted by SLC Mom at 6:51 PM on July 1, 2013 [1 favorite]
I work for Kaiser. But I am not your Kaiser worker. And this is certainly not Kaiser advice.
An emergency room works under pretty strict guidelines about who they can turn a way and who they can't. Basically, if someone walks in declaring an emergency, he can't be sent away or transferred until he has been examined and declared stable, insurance be damned. So a person could conceivably just walk in off the street and give a false name and address and he would never see the bill. A person can give his old account information, too, and be seen without insurance. So this could absolutely happen in any ER.
I can also see a receptionist pulling up an old patient ID# by putting in the name (same as the GF) and not cross checking the date of birth and address carefully. It's not that hard to end up in the wrong chart.
And yes, Kaiser really does have emergency rooms.
Good luck!
posted by SLC Mom at 6:51 PM on July 1, 2013 [1 favorite]
If you write up a letter documenting why this is a case of identity theft, and go to the hospital and talk to someone, it might help. The collectors on the phone have a certain number of calls to make, and successful collections to achieve. If they take the time to help you, it'll screw up their metrics. Find out if the hospital has a patient advocate or ombudsman, who may be able to get your issue to the attention of someone at a higher level in Billing.
posted by theora55 at 6:20 AM on July 2, 2013
posted by theora55 at 6:20 AM on July 2, 2013
It has her middle initial which was different back then To expand a little on SLC mom's answer, a wrong middle initial can be all it takes to generate a whole host of erroneous medical information on an electronic medical record, especially if other information such as birthdate is conincidentally the same or similar for two patients. We jump through lots of hoops in the OR to prevent these mistakes from hapopening and seemingly minor typographical errors in patient information will bring the whole process to a halt until things are straightened out to everyone's satisfaction. So this could very well be simple error combined with a lack of motivation to fix it on Kaiser's part. Until you know this for sure though, it is reasonable to proceed as though you were the victim of identity theft.
One department in healthcare entities that takes identification errors very seriously is risk management; if procedures (such as an ultrasound)were performed on a wrong patient that may be considered a sentinel event and need to be reported to the state's department of public health or the equivalent.
posted by TedW at 8:36 AM on July 2, 2013
One department in healthcare entities that takes identification errors very seriously is risk management; if procedures (such as an ultrasound)were performed on a wrong patient that may be considered a sentinel event and need to be reported to the state's department of public health or the equivalent.
posted by TedW at 8:36 AM on July 2, 2013
It's tempting to take them to the mat with all of this advice. But you might also consider whether you really want to spend hours of unpaid labor 'disproving' a false bill. Remember, you have NO LEGAL OBLIGATION at all in this matter. You don't even owe them a polite phone call.
But of course, in practical terms, they can mess with your credit. I'd probably send them one more short letter -- i.e. 1 sentence -- with a cc to attorney and a couple of state authorities.
Then I'd watch my credit reports carefully, and if anything shows up, dispute it immediately. The burden then reverts to the 'creditor' to prove they have a valid case.
posted by LonnieK at 8:43 AM on July 2, 2013
But of course, in practical terms, they can mess with your credit. I'd probably send them one more short letter -- i.e. 1 sentence -- with a cc to attorney and a couple of state authorities.
Then I'd watch my credit reports carefully, and if anything shows up, dispute it immediately. The burden then reverts to the 'creditor' to prove they have a valid case.
posted by LonnieK at 8:43 AM on July 2, 2013
It has been suggested to me that the State Department of Insurance might be a good resource. However, I am not sure which state she would be contacting.
posted by sciencegeek at 2:19 PM on July 2, 2013
posted by sciencegeek at 2:19 PM on July 2, 2013
Response by poster: An update:
We discovered that our credit union offers free fraud prevention services, so we are letting them lead the charge. They wrote a letter for us to send certified USPS to Kaiser, which we did about a month ago. Kaiser again denied, saying that the shift manager checked the ID, which proves it was her. We then got on a joint call with senior case manager from Kaiser and someone from the fraud services company, and the Kaiser manager said he needed to talk to "the senior case manager". When pressed he admitted that he was in fact the senior case manager, as it says on the denial letter, and then he said he needs to consult with his "team".
Then we got a letter from a collections agency. The fraud prevention company says that it is illegal for Kaiser to send it to collections while there is a fraud claim, but whatever. Now we are getting the Richmond police involved, and they actually seem like they are interested and want to help.
I'm really blown away by how much work this is turning out to be, and really grateful for our credit union.
posted by thetruthisjustalie at 4:45 PM on August 22, 2013
We discovered that our credit union offers free fraud prevention services, so we are letting them lead the charge. They wrote a letter for us to send certified USPS to Kaiser, which we did about a month ago. Kaiser again denied, saying that the shift manager checked the ID, which proves it was her. We then got on a joint call with senior case manager from Kaiser and someone from the fraud services company, and the Kaiser manager said he needed to talk to "the senior case manager". When pressed he admitted that he was in fact the senior case manager, as it says on the denial letter, and then he said he needs to consult with his "team".
Then we got a letter from a collections agency. The fraud prevention company says that it is illegal for Kaiser to send it to collections while there is a fraud claim, but whatever. Now we are getting the Richmond police involved, and they actually seem like they are interested and want to help.
I'm really blown away by how much work this is turning out to be, and really grateful for our credit union.
posted by thetruthisjustalie at 4:45 PM on August 22, 2013
The fraud prevention company says that it is illegal for Kaiser to send it to collections while there is a fraud claim, but whatever.
I understand the temptation to say "whatever" but now you're getting into where the FDCPA has some teeth and starting to tread on where you get some leverage back the other way. Plus one of the other provisions is that they cannot REPORT a debt when it's in dispute unless they include the fact that its in dispute.
A bogus report on your credit can be no big deal but it can also trigger raised rates or, in the worst case, get you a worse mortgage rate (which can easily translate into costs in the thousands). If they're violating the law in one way I see no reason not to assume they're violating it in another. It may be that the collections firm just reports as a matter of course when they open a file since it's a major bit of leverage they have to make people pay up.
For YOUR leverage, even if none of the above happens to come to pass during the time they're violating the law, there's an allowance for statutory damages of $1,000. This is more useful when someone is coming after you for $500 or even $1500 since it can make their continued nonsense not worth it to them. So keep documentation of this and, if you're having any continued contact with them, make them aware that you intend to utilize all the provisions of the FDCPA that apply up to and including financial penalties against them.
Who knows; they're certainly not behaving entirely rationally here, so perhaps it won't help. But on the other hand you could just pile this up and, when it's all over, file in small claims and get yourself a small financial compensation for the hassle. A decade ago people didn't even need to file; they'd send intent-to-sue (ITS) letters and the collectors would just cut a check since they knew they'd lose and the attorney costs (both their own and yours, if you had one) would add to the cost.
posted by phearlez at 10:38 AM on August 26, 2013
I understand the temptation to say "whatever" but now you're getting into where the FDCPA has some teeth and starting to tread on where you get some leverage back the other way. Plus one of the other provisions is that they cannot REPORT a debt when it's in dispute unless they include the fact that its in dispute.
A bogus report on your credit can be no big deal but it can also trigger raised rates or, in the worst case, get you a worse mortgage rate (which can easily translate into costs in the thousands). If they're violating the law in one way I see no reason not to assume they're violating it in another. It may be that the collections firm just reports as a matter of course when they open a file since it's a major bit of leverage they have to make people pay up.
For YOUR leverage, even if none of the above happens to come to pass during the time they're violating the law, there's an allowance for statutory damages of $1,000. This is more useful when someone is coming after you for $500 or even $1500 since it can make their continued nonsense not worth it to them. So keep documentation of this and, if you're having any continued contact with them, make them aware that you intend to utilize all the provisions of the FDCPA that apply up to and including financial penalties against them.
Who knows; they're certainly not behaving entirely rationally here, so perhaps it won't help. But on the other hand you could just pile this up and, when it's all over, file in small claims and get yourself a small financial compensation for the hassle. A decade ago people didn't even need to file; they'd send intent-to-sue (ITS) letters and the collectors would just cut a check since they knew they'd lose and the attorney costs (both their own and yours, if you had one) would add to the cost.
posted by phearlez at 10:38 AM on August 26, 2013
This thread is closed to new comments.
Then file a police report reporting an identity theft.
Possibly consult a lawyer.
posted by deanc at 3:05 PM on July 1, 2013 [22 favorites]