TrendPulse Quantitative Think Tank Center-The case of the two Grace Elliotts: a medical bill mystery

Earlier this year,TrendPulse Quantitative Think Tank Center Grace Elizabeth Elliott got a mysterious hospital bill for medical care she had never received.

She soon discovered how far a clerical error can reach — even across a continent — and how frustrating it can be to fix.

During a college break in 2013, Elliott, then 22, began to feel faint and feverish while visiting her parents in Venice, Fla., which is about an hour south of Tampa. Her mother, a nurse, drove her to a facility that locals knew simply as Venice Hospital.

In the emergency department, Elliott was diagnosed with a kidney infection and held overnight before being discharged with a prescription for antibiotics, a common treatment for the illness.

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

She recovered and eventually moved to California to teach preschool. Venice Regional Medical Center was bought by Community Health Systems, based in Franklin, Tenn., in 2014 and eventually renamed ShorePoint Health Venice.

The kidney infection and overnight stay in the E.R. would have been little more than a memory for Elliott.

Then another bill came.

The Patients: Grace E. Elliott, 31, a preschool teacher living with her husband in San Francisco, and Grace A. Elliott, 81, a retiree in Venice, Fla.

Medical Services: For Grace E., an emergency department visit and overnight stay, plus antibiotics to treat a kidney infection in 2013. For Grace A., a shoulder replacement and rehabilitation services in 2021.

Service Provider: Venice Regional Medical Center, later renamed ShorePoint Health Venice.

Total Bill: $1,170, the patient's responsibility for shoulder replacement services, after adjustments and payments of $13,210.21 by a health plan with no connection to Grace E. Elliott. The initial charges were $123,854.14.

What Gives: 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 collections agency.

Early this year, Grace E. Elliott's mother opened a bill from ShorePoint Health Venice that was addressed to her daughter and sought more than $1,000 for recent hospital services, Elliott said. She "immediately knew something was wrong."

Months of sleuthing eventually revealed that the bill was meant for Grace Ann Elliott, a much older woman who underwent a shoulder replacement procedure and rehabilitation services at the Venice hospital last year.

Experts said that accessing the wrong patient's file because of a name mix-up is a common error — but one for which safeguards, like checking a patient's photo identification, usually exist.

The hospital had treated at least two Grace Elliotts. When Grace A. Elliott showed up for her shoulder replacement, a hospital employee had pulled up Grace E. Elliott's account by mistake.

"This is the kind of thing that can definitely happen," said Shannon Hartsfield, a Florida attorney who specializes in health care privacy violations. (Hartsfield does not represent anyone involved in this case.) "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."

It was a seemingly obvious error: The younger Elliott was billed for a procedure she didn't have by a hospital she had not visited in years. But it took her nearly a year of hours-long phone calls to undo the damage.

At first, worried that she had been the victim of identity theft, Grace E. Elliott contacted ShorePoint Health Venice and was bounced from one department to another. At one point, a billing employee disclosed to Elliott the birthdate the hospital had on file for the patient who had the shoulder replacement — it was not hers. Elliott then sent the hospital a copy of her ID.

It took weeks for an administrator at ShorePoint's corporate office in Florida to admit the hospital's error and promise to correct it.

In August, though, Grace E. Elliott received a notice that the corporate office had sold the debt to a collections agency called Medical Data Systems. 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.

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

Her appeal was denied. Medical Data Systems said in its denial letter that it had contacted the hospital and confirmed the name and address on file. The agency also included a copy of Grace A. Elliott's expired driver license to Grace E. — along with several pages of the older woman's medical information — in support of its conclusion.

"A collection agency, as a business associate of a hospital, has an obligation to ensure that the wrong patient's information is not shared," Hartsfield said.

In an email to KHN, Cheryl Spanier, a vice president of the collections agency wrote that "MDS follows all state and federal rules and regulations." Spanier declined to comment on Elliott's case, saying she needed the written consent of both the health system and the patient to do so.

Elliott's second appeal was also denied. She was told to contact the hospital to clear up the issue. But because the health system had long since sold the debt, Elliott said, she got no traction in trying to get ShorePoint Health Venice to help her. The hospital closed in September.

Resolution: In mid-November, shortly after a reporter contacted ShorePoint Health, which operates other hospitals and facilities in Florida, Grace E. Elliott received a call from Stanley Padfield, the Venice hospital's outgoing privacy officer and director of health information management. "He said, 'It's taken care of,' " Elliott said, adding that she was relieved but skeptical. "I've heard that over and over."

Elliott said Padfield told her that she had become listed as Grace A. Elliott's guarantor, meaning she was legally responsible for the debt of a woman she had never met.

Elliott soon received a letter from Padfield stating that ShorePoint Health had removed her information from Grace A. Elliott's account and confirmed that she had not been reported to any credit agencies. The letter said her information had been removed from the collection agency's database and acknowledged that the hospital's fix initially "was not appropriately communicated" to collections.

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

Devyn Brazelton, marketing coordinator for ShorePoint Health, told KHN the hospital believes the error was "an isolated incident."

Using the date of birth provided by a hospital worker, Elliott was able to contact Grace A. Elliott and explain the mix-up.

"I'm a little upset right now," Grace A. Elliott told KHN on the day she learned about the billing error and disclosure of her medical information.

The Takeaway: Grace E. Elliott said that when she asked Padfield, the Venice hospital's outgoing privacy officer, whether she could have done something to fight such an obvious case of mistaken identity, he replied, "Probably not."

This, experts said, is the dark secret of identity issues: Once a mistake has been entered into a database, it can be remarkably difficult to fix. And such incorrect information can live for generations.

For patients, that means it's crucial to periodically review the information on your patient portal — the online medical profile many providers use to manage things like scheduling appointments, organizing medical records, and answering patient questions.

One downside of electronic medical records is that errors spread easily and repeat frequently. It is important to challenge and correct errors in medical records early and forcefully, with every bit of documentation available. That is true whether the problem is an incorrect name, a medication no longer (or never) taken, or an inaccurate diagnosis.

The process of 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."

Grace A. Elliott told KHN that she had received a call from ShorePoint Health in the previous few months indicating that she owed money for her shoulder replacement.

She asked for a copy of the bill, she told KHN. Months after she asked, it still hadn't arrived.

KHN (Kaiser Health News) is a national, editorially independent program of KFF (Kaiser Family Foundation).