HOSPITAL BILLING: UCI Revamps System To Prevent Abuse
The University of California-Irvine Medical Center is radically revamping its billing system to address abuses that led to the closing of its cancer research lab. The Los Angeles Times reports that in response to 18 patients being erroneously billed for experimental treatments in 1995 and 1996, the UCI Medical Center will "assign a nurse to each research project to determine in advance" who will bear the responsibility for payment, and will abolish department-based billing in lieu of a single hospital-wide system. The Chao Family Comprehensive Cancer Center lab was shut down in 1996 "after UCI found that researchers engaged in unauthorized experiments and practices" and "insurers and patients paid for work that should have been billed to the research program." According to officials, state and federal law prohibits "payments for experimental drugs, treatments or procedures performed as part of a research protocol." UCI Medical Center Executive Director Mark Laret said, "We have known this is something we had to get done. All this thing does is reinforce why this is critical to have in place. We knew it was important." He explained that "[c]onfusion and incorrect billing in the case of research patients is something that happens at hospitals around the country." The Times reports that the "difficulty in identifying charges" often arises in cases where for study purposes researchers ask for more tests than are medically necessary. In cases such as those, the "question of whom to bill could be complex or easily confused."
Conflicts Of Interest
In the Chao Cancer Center lab, "research was privately funded by Meyer Pharmaceuticals, which was co-owned by several of the doctors involved in the research. ... As a result, bill shifting could have meant that the research program was able to save money by not paying for treatment and tests required by the research." Laret said, "In the past, it used to be that a researcher would bill the insurance carrier and if they paid, then that is how it went. That era has come and gone [and] it is just not acceptable" (Warren/Kern, 1/7).