Auditor's Comments on Agency Response
The Office for Hospital Patients, in its response, does not agree with certain of our findings, conclusions, and recommendations. The following identifies those sections of the report where the Office has taken exception to our position. We have provided our comments on the Office's response to assure the reader we believe our findings, conclusions, and recommendations, as stated in the report, are appropriate.
1. The Office disagrees with our conclusion that reporting unbilled charges as patient relief distorts the Office's performance. The Office states that without its intervention, the patient would still owe money on the undercharge, which had been posted to his account after the bill had been investigated. (See page 17)
Legislative Auditor's Comment
As stated on page 10, hospitals have the option of increasing a patient's bill if they discover charges that were not posted in the original bill. Even though a hospital elects not to charge the patient for the newly discovered unbilled charges, the Office reports the unbilled charges as patient relief because of its policy. We believe that since unbilled charges were not assessed, reporting the unbilled charges as patient relief is questionable. For example, one hospital initially billed a patient $112,189 for services. The patient filed a complaint with the Office alleging the bill was too high. The Office contacted the hospital about the complaint. The hospital's auditor found $74,580 of unbilled charges. The hospital decided not to charge the patient for the unbilled items; however, the Office reported these unbilled charges as patient relief. Additionally, there is no evidence that without the Office's intervention the hospital would have discovered and re-billed the patient for the additional charges. Therefore, the argument that the patient would have had to pay the additional money without the intervention of the Office is unsubstantiated.
2. The Office claims to take credit for patient relief only if it was
instrumental in obtaining the relief for the patient and states that the
audit has failed to illustrate that the Office has done otherwise. Additionally,
the Office rejected the recommendation that it review and develop methodologies
to ensure accurate reporting of patient relief because it is difficult
to do without statutory alternatives. (See page 17)
Legislative Auditor's Comments
The Office claims that it was instrumental in obtaining patient relief in many of the cases we tested, but was unable to provide evidence. Therefore, we feel that our assertion that the Office took credit in cases where patient relief was initiated by others is valid. As discussed on page 11, there was no evidence that the Office intervened with the insurance company or the hospital charity on a patient's behalf to obtain payment of a hospital bill. The patient's insurance was through the State of Nevada. The hospital had a contract with the State to pay the patient's bill on a per diem basis. Between the insurance and a charitable organization, the patient's entire $15,380 bill was paid and the Office reported this amount as patient relief. The Office could provide no evidence that the Office intervened with the insurance company or the charity.
In another case discussed on page 12, based on the hospital's correspondence, the hospital offered a patient the opportunity to enter an internal free care charity plan before the Office acted on the complaint. The patient originally refused to enter the program. After the patient filed a complaint with the Office, the patient entered the free care program. The Office did not make reference to the free care program in any correspondence with the hospital. The Office reported patient relief of $13,020, even though the hospital initiated the process that resolved the bill, not the Office.
3. The Office states that it has limited statutory authority and cannot require hospitals to submit documentation in specified formats. Therefore, notes from phone calls are sometimes the only evidence of an agreement between the Office and a hospital. The response also states the agency should not be faulted for failure to obtain correspondence since it cannot force hospitals to respond in any specified format. (See page 18)
Legislative Auditor's Comments
On page 12, we acknowledge that the Office has limited statutory authority. However, statutory authority is not needed for the Office to request information. The recommendation is that the Office "request hospitals to provide sufficient documentation to support reported patient relief." The Office regularly corresponds and requests information from hospitals. Additional or follow-up correspondence is not barred by statute.
4. The Office states once a settlement is negotiated between a hospital and the patient, it is beyond the scope of its jurisdiction to follow-up on the fulfillment of the agreement. (See page 18)
Legislative Auditor's Comments
The Office has reported patient relief, as discussed on page 11, where it has negotiated an agreement between a hospital and patient, and the bill is discounted if the patient meets certain payment requirements. In one case, the patient would be required to make a payment of $13,500 to have a bill discounted $16,275. The Office reported the discount as patient relief even though it did not have any evidence that the patient accepted the conditions. Additionally, the settlement did not require payment until January 15, 1995, but the Office claimed relief for the quarter ending December 31, 1994.
As stated earlier, the Office does not need statutory authority to request information from hospitals to perform follow-ups.
The Office has rejected the recommendations to (1) review and develop methodologies to ensure accurate reporting of patient relief and (2) request hospitals to provide sufficient documentation to support reported patient relief. The Office reports patient relief in its quarterly reports to the Legislative Committee on Health Care and uses patient relief as a performance indicator in the executive budget. Information supplied to the Legislature should be accurate and reliable. We do not believe that specific statutory authority is needed in order to provide accurate and reliable information. The Office developed its methods for reporting patient relief. Specific statutory authority is not needed to change its reporting methodologies to ensure accurate reporting.