Consumer complaint received 2020-09-15
Product: Debt collection — Medical debt
Issue: False statements or representation — Attempted to collect wrong amount
Company: Ability Recovery Services, LLC (FL)

XX/XX/XXXX XXXX XXXX XXXX  XXXX XXXX TX & XXXX Dispute results report # XXXX for XX/XX/XXXX ARS Account Resolution Services XXXX XXXX XXXX XXXX, PA XXXX Ability Recovery Service XXXX XXXX XXXX XXXX, PA XXXX XXXX XXXX XXXX, XXXX XXXX XXXX XXXX XXXX, PA XXXX Tax ID : XXXX Patient account # XXXX I reviewed XXXX response to my dispute in which XXXX   determined my dispute was not sufficient to make any changes or deletions I requested. I want to ask XXXX  what exactly was insufficient about my dispute when I asked the collection agency for additional details validating the alleged debt of {$910.00} for XXXX XXXX, a level 3 emergency room code for a bruise on my leg that did not get treatment of any kind. 


ARS Account Resolution has not written to me to properly validate this debt. They have not responded to the second letter I sent them via certified mail ( first letter and second letter both signed by XXXX XXXX ) asking them to provide additional details to validate this debt that claims I received level-3 emergency treatment by the provider XXXX XXXX XXXX. 

I believe the reason Ability Recovery Service or ARS Account Resolution are unable to validate this debt precisely because the creditor can not justify the level-3 CPT code used ( XXXX ). The provider can not substantiate having administered treatment at that CPT code level ( level-3 ). The amount billed goes together with the level-3 code requiring the provider to use level-3 criteria ( moderate complexity ) in treating what was simply a bruise. The code equals the cost of treatment. I was not treated for anything. 
The doctor did not even touch me and hardly spent more than 5 minutes looking at it and said I would be fine. For these reasons, I believe this provider and creditor has inflated this bill by using diagnosis billing codes that indicate the patient experienced medical complications and/or needed more expensive treatment, for example, billing for when only simple services or even only an evaluation was performed. Listing treatment as having been for a more complicated medical diagnosis than was actually the case or billing for brand-named drugs when generic drugs were provided or no drugs were provided is fraud.

I did not receive level-3 emergency treatment as evidenced by use of the CPT code XXXX, a code used for patients with problems of moderate severity. If I had a problem of moderate severity, there should also be a corresponding hospital code/bill. More serious codes demand higher payments. In my letter to XXXX/Ability Recovery Service, I asked the creditor to provide additional documentation of the alleged services I received under the level 3 CPT code XXXX. The reason they have not provided this information is because they can not. If this bill is valid, then I ask, what exactly was I treated for at a level-3? Therefore, why am I to pay for level 3 emergency evaluation and management I never received? What protects people who have no insurance from such exploitation? The provider must understand that individuals have little or no recourse. Insurance companies would challenge a bill without supporting medical documentation. I am asking for transparency in this matter from the provider and collection agency otherwise I will be stuck paying a debt that is not valid.

This is a type of fraud called " upcoding '' which is billing for a higher level of care than was provided. Upcoding is illegal. It is a way of cheating the system. Intentional upcoding violates the False Claims Act. As a patient, I expect that when a provider bills me, the provider  certifies that every code billed is supported by medical record documentation - which is impossible if the provider has upcoded - which is my suspicion in this case. 

I wonder how this bill compares with similar bills covered by insurance companies. I believe this provider ( XXXX XXXX XXXX ) has overcharged the patient ( {$910.00} XXXX XXXX eval and management - lvl 3 ) for " evaluation, management '' and treatment that were never given or consented to during the ER visit. Level-3 equals a problem of moderate medical complexity. A minor injury- a bruise - is being reported as a level-3 condition making it a more serious condition for the provider to treat and thus, the provider charges higher fees. A review of the information from the provider  will examine the services rendered by both the provider and hospital to ascertain the said services were indeed at a level 3 category for the provider to have used the correct procedure code, XXXX which is the code used in this case. This is a predatory form of fraud exploiting those of us who do not carry health insurance. A insurance company would scrutinize the bill and would not accept such vague coding for nearly {$1000.00} without supporting documentation and doctors notes to back up the medical necessity of treatment provided. 

By law a patient is obligated to pay the rate of the emergency room charges for services if : 1. the patient consented ( by signature ) to receive the services ; and 2. the patient actually received said services ( I never got any treatment ) It is my understanding from research that a patient is not legally obligated to pay for any emergency room services that they did not actually receive or consent to. If the patient was overcharged during the emergency room visit, what recourse does the patient have? The provider, in this case, is taking full advantage of the fact that I likely can not perform the same billing scrutiny as an insurance company. Is the {$910.00} charged comparable to how the provider would bill an insurance company for the services/treatment rendered? How would the provider justify the use of the XXXX CPT code if I was XXXX or XXXX? 

This is why the only way an individual can find overcharges is to : 1. Request an itemized statement of the bill to see if the charges correspond to the treatment ( if any ), given ; 2. Establish whether signature consent for said procedures or treatment was given by the patient ; 3. Have my personal doctor review the billing statements/doctors notes, 4. Ask for the hospital to audit the providing doctors statements ; ( why is there no corresponding hospital/facility bill for the same? ) ; 5. Determine if  treatment/procedure was medically necessary ; 6. Ask the provider/hospital billing department for adjustments for anything the patient did not consent to via signature ; 7. Have a patient advocate negotiate with the hospital/provider over inaccuracies. 

Question : Should I be denied a detailed explanation of charges simply because I am not a big and powerful insurance company? If XXXX XXXX XXXX, XXXX would fail to overcharge an insurance provider, why should they succeed in overcharging an individual? It is an abuse of power. The principle of billing and applying medical billing codes accurately should be equivalent to how much insurance companies pay for the same treatment/care. XXXX  has advised me to either file a complaint against XXXX or the debt collector or the provider with the Consumer FinancialProtection Bureau which is the purpose of this complaint. 

I have requested that XXXX re-evaluate the validity of this bill from XXXX XXXX XXXX, XXXX a bill now pursued by ARS/Ability Recovery Services debt collection agencies. I stand by the fact that if I was a patient in an emergency room, I should only be charged for treatment I actually received. I believe I have been charged for treatment that was never rendered to me. My treatment records could be mixed up with another patient who was a level-3 patient or are the result of clerical error or provider fraud ( upcoding ). 

Sincerely, XXXX XXXX XXXX