Providence St. Joseph Medical Center is among dozens of hospitals
nationwide tapped by federal lawmakers investigating hospital billing
Lawmakers from the House Energy and Commerce Committee and the
Oversight and Investigations Committee are looking into whether the
uninsured are shouldering larger payments for medical services than
medical insurers that have already bargained rates with providers.
As part of their investigation, Reps. Billy Tauzin (R-La.) and
James Greenwood (R-Pa.) sent a letter last week to 20 hospital chains
nationwide seeking information about how they bill their patients and
how they set their rates.
Among the information requested by lawmakers are specific records
for each chain and individual hospital dating back to 1998. That
information includes net operating income, revenue collected per
patient per day under Medicare and Medicaid, revenue from uninsured
patients, cost-to-charge ratios and rate formulas.
At Providence, the letter has staff scurrying to meet the July 31
deadline for providing information.
“The primary effect is that our folks in our financial departments
at all of our hospitals are jumping into a data-gathering effort,”
said Steve Brennan, director of Public Policy and Regulatory Affairs
Of the 20 hospital chains, six are in California and three have
centers in Burbank and Glendale. Providence St. Joseph Medical Center
is part of the Washington-based Providence Health System, Glendale
Adventist Medical Center is part of the Roseville-based Adventist
Health, and Glendale Memorial is part of Catholic Healthcare West in
“We are not targeting a specific company, but we are targeting a
problem,” said Ken Johnson, a spokesman for the House Energy and
Commerce Committee, adding that in some cases, it appears hospital
companies are overbilling the uninsured compared to health plans set
by other companies.
Lawmakers said so-called “self-pay” patients -- patients who have
no coverage through a third-party health plan and are not enrolled or
eligible for any government-sponsored program -- could be at
particular risk because providers increase costs to the uninsured to
make up for revenue lost in discounted plans to the insured.
“These rates are often inflated far beyond their actual costs and
reasonable profit due, in part, by the providers’ need to make up for
the steep discounts from charge master prices demanded by the
third-party health plans,” the letter said.