Revealed: How primary care is losing millions through hospital bill errors
By Steve Nowottny
A GP has exposed huge problems in the system for billing PCTs and practices for hospital activity, with vast sums being wrongly claimed from primary care.
Incorrect or incomplete invoices worth as much as £19 million have been submitted by secondary care in one PCT alone through the controversial payment by results system, with the length of hospital stay overstated by months in some cases.
The findings raise serious questions about the viability of GP commissioning, with practices and PCTs potentially overcharged by billions of pounds last year if the error rate was repeated nationally.
Dr Steven Lindall, a GP in Waltham Forest, east London, uncovered a mass of discrepancies after sifting through his practice data.
In 2008/9 alone, his practice was charged by Whipps Cross University Hospital NHS Trust for 1,476 payments where correspondence was still missing by the end of the year – worth an estimated £256,885.
The practice also had unresolved queries on invoices worth £233,477 at the end of the year – meaning payments worth a total of £490,362 were outstanding.
When Dr Lindall raised the alarm with his PCT, it appeared to simply write off the queried payments – claiming the ‘sheer volume' made them impossible to resolve before the cut-off dates to sign off performance.
A letter in August from NHS Waltham Forest chief executive Sally Gorham, seen by Pulse, states the PCT's practices submitted more than 10,000 individual data reconciliation queries to Whipps Cross last year.
It admits the claims management system at both the PCT and hospital trust ‘were unable to cope with this volume of queries'.
Dr Lindall estimated there could be incorrect invoices and invoices with missing correspondence worth more than £19m in his PCT alone.
‘I don't think [the PCT] is capable of organising an orgy in a brothel,' he said.
‘Mistakes typically involved Whipps Cross Hospital invoicing for a more expensive procedure than has been performed, or entering too long a duration of stay. Much of the correspondence would have resulted in a reduced invoice if it had been looked at properly.'
NHS Waltham Forest told Pulse it was unable to comment in detail as it was investigating a formal complaint from Dr Lindall.
A spokesperson for Whipps Cross University Hospital NHS Trust insisted it had a lower error rate than other London trusts, and said the Insource system used as basis for GP challenges was ‘not compatible' with its own data – a claim refuted by NHS Waltham Forest.
Dr Michael Dixon, NHS Alliance chair, said: ‘I fear this is common in PCTs that are not yet World Class Commissioners, and quite a lot could be recouped by simply getting the bills right. We are talking about many millions of pounds nationally.'
A Department of Health spokesperson said the Audit Commission's external audit of clinical coding could be widened to improve data quality: ‘The Commission is currently considering extending the programme to include other types of data, such as discharge dates, which can influence payment.'Some invoices said hospital stays lasted months when patient records suggested they'd been in for just weeks Some invoices said hospital stays lasted months when patient records suggested they'd been in for just weeks One error among hundreds
Among the errors identified by Dr Lindall was the case of one patient at his practice who, according to payment by results data, was admitted to Whipps Cross on 9 September 2008 with ‘asthma without complications' and discharged on 19 January 2009, at a total cost of £25,904.
However the discharge letter sent to the practice and the patient's medical records appear to confirm she was actually discharged on 29 September 2008 – meaning the practice and PCT were apparently overcharged by many thousands of pounds.