Michigan Health Department, Health Plan Accuse Hospitals of Overbilling for ER Care

The Michigan Department of Community Health and "at least one" health plan operating in Michigan "charge" that some hospitals in the state have "systematically" overbilled Medicaid and insurers for emergency room services, the Detroit News reports. Under Medicaid rules, hospitals should not treat patients in the ER when they can delay treatment 12 to 24 hours "without substantial difference in outcome" and should refer beneficiaries who do not require "immediate medical attention" to their primary care physicians. However, Geralyn Lasher, a spokesperson for the health department, said that a state audit has found that some hospitals bill Medicaid for ER services that "involve routine treatments." Bryan Schefman, CEO of Great Lakes Health Plan, added that he has received ER bills for non-emergency cases, including earaches, muscle aches, coughs and colds. Lasher and Schefman said hospitals that decide to treat non-emergency conditions rather than refer patients to a doctor should bill Medicaid and insurers for the services at a non-emergency rate. However, according to Pat Foley, a spokesperson for the Michigan Health & Hospital Association, member facilities have not "improperly" treated patients or overbilled for non-emergency care. Foley "accused" the state of "trying to pay lower rates for emergency services that hospitals have a moral and legal obligation to provide." The health department and Great Lakes have asked for a refund on bills that they said they "overpaid in error." Some hospitals have complied (Webster, Detroit News, 8/31). For further information on state health policy in Michigan, visit State Health Facts Online.