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Medicare Pays Six Times What Hospital Billed

U.S. Senator Says Changes Needed In The Program

UPDATED: 11:36 am MDT May 8, 2008

Medicare paid six times the cost of a minor operation for a Littleton woman, prompting a U.S. senator to say the program is out of control.

Mary Jorgenson stayed overnight in 2007 at Swedish Medical Center in Englewood to get an oxygen tube airway placed in her neck to treat a chronic lung condition.

She was shocked when she saw the amount the hospital received for the procedure.

"I got a summary notice dated one week after the surgery, after the procedure, that indicated (Medicare) had paid Swedish $65,979.50," she told told CALL7 Investigator John Ferrugia. "The little bells and whistles went off when I saw the amount that they received. I asked them how can you take this money when the bill is only $11,000?"

Records show the hospital had provided her documents that showed the operation was billed at about $11,000. Swedish received more than $65,000 for the procedure -- almost all of it from Medicare.

U.S. Sen. Wayne Allard, R-Colo., said the codes hospitals use to bill for procedures are so broad that often minor procedures are billed for thousands more than the hospital's bill.

"Sometimes the diagnostic related grouping is so broad that when the inspector general or somebody comes in and reviews it, it's so broad that it falls in and they say that that's fine," Allard said.

Swedish hospital spokeswoman Julie Lonborg declined to talk on camera about the situation, saying Medicare audited the case and found nothing wrong. Lonborg said the hospital handled 33 similar cases in 2007 but refused to say how much they cost the hospital or if the facility made a profit.

The hospital sent the bill two more times to Jorgenson's supplemental insurance, but the company did not pay the repeat billings.

Lonborg said the repeated payments were a mistake.

Allard said the situation highlights a systematic problem.

"They sent in a large bill just saying, 'Well, this category allows us to charge up to a certain amount. We'll just submit the maximum and see what happens,'" Allard said. "I think that Congress has to look at narrowing these groups some."

Jorgenson's bill was paid so the situation didn't affect her. She just thought it was wrong that Medicare was apparently wasting taxpayer money.

"There's something wrong here," Jorgenson said. "Obviously, there's something wrong. Is this why Medicare is screaming that they're going broke?”

Medicare declined comment.

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