Revealed: How primary care is losing millions through hospital bill errors
27 Oct 09
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.’
One error among hundreds
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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.
Readers' comments
As a lay member (LINk) of the local PCT's Clinical Governance and Quality Group, during a discussion about coding by the local hospital the outcome was identification of many errors - some in favour of the hospital but just as many in favour of the PCT.
In our acute trust an audit has just been conducted that shows the cost of incorrect coding is some 8m - in lost income to the trust. This is exactly the opposite of Dr Lindall's experience. Indeed I have just made a presentation at a hospital academic half-day to try and encourage clear data entry on discharge forms to enable coders to code more accurately, and for our hospital thereby to increase its income. Of course, the PCT may then cap its payments... If there really is a six-of-one, half-a-dozen-of-the-other situation perhaps we should abandon the whole billing system and dispose of the army of clerks and managers who oversee the system in both PCTs and acute Trusts. This is an artificial market, and it is a complete failure, doing little except distract clinicians from good patient care.
Too many administrators + too many chief executives = low quality products.
We would like to explore the data problems exposed in greater detail as we are undertaking similar audits in East Yorkshire. Can we have any more details of the problems and inconsistancies found? Our PCT member (Stewart Bentley) has asked that I try to track down more info to compare with local issues. Dr Clive Henderson GP
Thanks for the comment Dr Henderson - I've passed along your contact details to Dr Lindall.