After a woman received a hospital bill for care she did not receive, she soon discovered that a case of mistaken identity was responsible for the mix-up, Mark Kreidler writes for Kaiser Health News.

How a case of mistaken identity led to a medical billing error

In 2013, a 22-year-old woman named Grace Elizabeth Elliott went to the ED at Venice Regional Medical Center—later renamed ShorePoint Health Venice—after she started "to feel faint and feverish while visiting her parents in Venice, Florida," Kreidler writes.

During her visit, Elliott was held overnight after being diagnosed with a kidney infection. The following day, she was discharged with a prescription for antibiotics.

"My hospital bill was about $100, which I remember because that was a lot of money for me as an undergrad," said Elliott, who is now 31 years old.

Then, in early 2022, Grace E. Elliott's mother opened a bill from the hospital that was addressed to her daughter. According to the bill, Grace E. owed over $1,000 for recent hospital services. Her mother said she "immediately knew something was wrong."

The bill said Grace E. owed $1,170 for shoulder replacement and rehabilitation services in 2021. However, she was living with her husband in San Francisco at the time of service—and she had no connection to the health plan that was listed on the bill.

After investigating the charge for months, they discovered that the bill was meant for Grace Ann Elliott, an 81-year-old woman who underwent a shoulder replacement procedure and received rehabilitation services at the hospital in 2021.

According to Kreidler, "[e]xperts said that accessing the wrong patient's file because of a name mix-up is a common error." However, there are typically safeguards, including checking a patient's photo identification, to help prevent these kinds of errors.

"This is the kind of thing that can definitely happen," said Shannon Hartsfield, a Florida attorney who specializes in health care privacy violations. "All kinds of human errors happen. A worker can pull up the names, click the wrong button, and then not check [the current patient's] date of birth to confirm."

"This is a case of mistaken identity, a billing mystery that started at a hospital registration desk and didn't end until months after the file had been handed over to a collection agency," Kreidler adds.

The billing mix-up took 'nearly a year' to resolve

While the mix-up seemed like an "obvious error," in which Grace E. was billed for care she did not receive by a hospital she had not visited in years, "it took her nearly a year of hours-long phone calls to undo the damage," Kreidler writes.

Initially, Grace E. was worried she had been the victim of identity theft. When she contacted the health system, she spoke to a billing employee who told her the birthdate of the patient who had the shoulder replacement. To show that her birthdate did not match the patient's, Grace E. sent the hospital a copy of her ID.

A few weeks later, a hospital administrator admitted the hospital's error and told Grace E. that it would be corrected.

Then, Grace E. received a notice that the debt had been sold to a collection agency called Medical Data Systems (MDS). "Even though the hospital had acknowledged its error, the agency was coming after Grace E. Elliott for the balance due for Grace A. Elliott's shoulder surgery," Kreidler writes.

"I thought, 'Well, I'll just work with them directly,'" Grace E. said.

However, her appeal—and subsequent reappeal—were denied. Grace E. "was told to contact the hospital to clear up the issue," Kreidler writes. However, since the health system had already sold the debt, Grace E. did not get much help from the hospital, which closed in September.

Then, in mid-November, Grace E. received a call from Stanley Padfield, the hospital's outgoing privacy officer and director of health information management. "He said, 'It's taken care of,'" Elliott recalled, noting that she felt relieved but skeptical. "I've heard that over and over."

In a letter, Padfield said that Grace E.'s information was removed from MDS' database, adding that the hospital's previous resolution "was not appropriately communicated" to collections.

According to Padfield, the error started with a "registration clerk," who he said had "received additional privacy education as a result of this incident."

Separately, Devyn Brazelton, the health system's marketing coordinator, said the hospital believes the error was "an isolated incident."

Still, clerical errors are not uncommon—and patients should regularly review the information on their patient portals.

Since the information in EMRs is often copied and transferred, "errors spread easily and repeat frequently," Kreidler writes. "It is important to challenge and correct errors in medical records early and forcefully, with every bit of documentation available."

Amending a record can be "very involved," Hartsfield said. "But with patients able now to see more and more of their medical records, they are going to want those amendments, and health systems and their related entities need to get prepared for that." (Kreidler, Kaiser Health News, 12/21)