Mistake Results in Medicare Statement for Deceased Wife

He opened his mail and then had to sit down. A statement showed his wife had recently undergone medical treatment. Problem is she's been dead for five years.

Jim Bowens lost his son, Matt, a Detroit Police officer killed in the line of duty, in February of 2004. Then just nine months later, Jim's wife, Carole, died after being diagnosed with lupus. But in June, Bowens was stunned when he opened his mail and found a Medicare statement indicating Carole had several medical treatments in May of 2010.

"I was going to call the doctor's office up and (say) when's her next appointment so I can go see her," said Bowens.

Before her death, Carole Bowens was a patient at the Professional Physical Therapy Clinic in Dearborn. When I met with the clinic president, Sami Ahmad, he explained it was an honest mistake. An employee doing the statement benefits accidentally mixed up the name of a current patient with Bowens. The two last names are similar in spelling.

The clinic says they noticed the error and contacted Medicare, but Bowens statement was already in the mail.

"It was, in fact, just a billing error and no fraud was taking place. Our family's been in this business for more than 30 years. We provide excellent patient care. We thrive on our ethics, and we would not be in business for so long if we were not able to do that," Ahmad said.

When people inquire as to why a deceased patient's name is even held in a medical facility computer, Ahmed says he's required to hold those records.

"Medicare and all insurances require we keep our records for seven years," said Ahmad.

The Medicare statement showed Dr. Sylvia Loving as authorizing a referral for treatment for Carole Bowens, and Stephen Macko was also shown by Medicare as providing physical therapy, even though neither of them did.

It was also all part of the billing error by the clinic employee.

"Dr. Loving happens to be one of our high referring podiatrist doctors. She's new in (the) Dearborn area, and she's an excellent podiatrist," Ahmad said. "Our therapist, Stephen Macko, also happens to be one of our best PTs. He's been a therapist for more than ten years. Every patient we've had loves him."

Lessons learned? Always check your statements of service for accuracy, and Medicare recommends if you do have a question, check with your doctor or service provider first. They may be able to figure it out.