[Editor's Note: Please refer to https://www.grantcountybeat.com/news/news-articles/grmc-ceo-issues-public-notice-on-er-electronic-documentation-process-issues?highlight=WyJncm1jIiwiY2VvIl0= to clarify that GRMC already knew about this and has taken steps to correct it.}

I am a retired medical doctor and a thirty year resident of Silver City. I spent 23 years of my medical career as an anesthesiologist at the Gila Regional Medical Center (GRMC), and during that time I held almost every medical staff leadership position at the hospital, including a term as the Chief of Staff.

About eight weeks ago I discovered that the hospital had severely over-charged an ER patient for their medical care. This happened as a result of up-coding, where instead of using the correct billing code for the treatment, the billing office substitutes a code for a much more expensive level of care. I delivered a letter to the offices of both the billing department director and the CEO on 9-2-24, asking them to correct this error and to send a new bill to the patient. There was no response from the hospital. Two weeks later the patient received a pre-bill showing the same error. I then made multiple attempts to speak with the billing director and the CEO, but no calls were returned or even acknowledged. Six weeks after the ER visit, the patient received the actual bill, still containing the up-coded charge. This one code increased the patient's bill by over 25%, which corresponds to more than $1000. The patient paid the bill, and again I made multiple attempts to speak with the CEO. His response was total silence.

Last Wednesday, October 23rd, I made a presentation to the hospital Board of Trustees, informing them that the hospital was engaging in illegal up-coding of some patient charges, which is a Federal crime under the False Claims Act, and that I was concerned that this was being done deliberately. Although there is no evidence yet, one person alone at the hospital could not be responsible for this. On the basis of the hospital's failure to respond to my attempts to contact them, I suspect that members of the administration, the billing office and the information technology departments may be involved. When I spoke to the hospital Board, they were seriously concerned and were clearly unaware of this situation.

I have notified Federal and State officials of this illegal activity, as well as several medical insurance companies who have also possibly been overcharged. It is not clear how long this has been going on, nor whether it only involved ER charges or other hospital charges as well. The Federal fines for up-coding are as high as $20,000 for each up-coded bill sent out.

It is so sad that this has occurred at our hospital, but remember that the doctors, nurses, and most of the other employees were not involved in this, and are hearing about it now just as you are.

Mark S Donnell, MD