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StumbleLawsuit alleges UMC misclassified patients, overcharged millions
The entrance to University Medical Center’s trauma unit and emergency room is shown in 2009.
Monday, June 14, 2010 | 1:33 p.m.
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- Patient privacy scandal at UMC goes from rumor to indictment (4-29-2010)
- Man indicted in probe of UMC privacy leak (4-28-2010)
- Source may hold key in solving UMC patient data leak (3-8-2010)
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- UMC: Patient info leaks likely date back to July (1-25-2010)
- UMC faces criticism from within medical field (12-23-2009)
- UMC suspends 6 staff members pending investigation(12-11-2009)
- At UMC, audits show privacy lapses are not new(11-24-2009)
- FBI looking at UMC records leak(11-21-2009)
- Hospital privacy leak could harm patients(11-20-2009)
A lawsuit seeking class action status has been filed against University Medical Center, claiming the Las Vegas hospital has overcharged thousands of patients millions of dollars over the years by misclassifying them as trauma patients.
The suit, filed Thursday in Clark County District Court, says that on March 31, Karla Reyes-Sandino of Las Vegas was treated for 90 minutes at UMC for neck pain after a car accident.
A nurse evaluated the patient and found she did not meet "trauma field criteria," the lawsuit says.
A CT scan of her brain and spine found them to be normal and she was discharged in good condition, the lawsuit says.
In April, Reyes-Sandino was billed $11,830, including $8,109 in "trauma" charges despite her not being assessed as a trauma patient, the lawsuit says.
"For years, UMC unlawfully billed and collected from emergency room patients millions of dollars in 'trauma' charges when the patients were not trauma patients, and/or were misclassified by UMC as trauma patients and/or did not utilize UMC’s trauma facilities in order to allow UMC to unlawfully ... bill each patient thousands of dollars in additional medical charges," the lawsuit charges.
Henderson attorney Jesse Sbaih, who filed the lawsuit, said he’s aware of at least two other patients who had similar experiences with UMC.
In the case of Reyes-Sandino, Sbaih said UMC eventually agreed to lower the bill to $7,800 – an amount Sbaih maintains is still inflated by UMC misclassifying his client as a trauma patient.
Sbaih said that even when an insurance company pays the UMC bill, patients like Reyes-Sandino are still harmed by UMC’s practice.
He said that’s because, under a typical auto insurance policy, money paid by the insurer to UMC reduces the money available for payment to the patient for her pain and suffering.
The suit asserts claims of violations of the Nevada Deceptive Trade Practices Act, fraud and unjust enrichment.
UMC has not yet responded to the lawsuit. A message for comment was left with the hospital Monday.
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Misclassifying people as trauma patients, when they are not, is the tip of the iceberg.
My daughter is a patient of a UNLV Med School faculty member, and is seen at the office of that physician, part of the large "faculty" medical practice. As a result, I am familiar with the time frame involved in what could be called short, medium and long office visits. She has never been ripped off by that physician.
However, my daughter and granddaughter have also been treated at UMC Quick Care. Both times, they were charged for a "medium" office visit, when the physician was in the room less than 2 minutes. The first time I wrote Kathy Silver a very indignant letter, accusing the physician of fraud, and UMC Quick Care of fraud. I got back a letter which refused to correct the over-billing but cut back the bill to a lower level claiming that all Nevadans are entitled to a "cash discount" at UMC Quick Care if they pay up front, which we had. I HAVE SUBSEQUENTLY LEARNED THAT CASH DISCOUNT IS NOT DISCLOSED TO UMC QUICK CARE PATIENTS, UNLESS THEY COMPLAIN ABOUT BOGUS BILLING.
As to the fraudulent billing on my granddaughter's visit to UMC Quick Care, I simply sent a letter to the insurance company which covered my granddaughter.
However, as a family we have figured out that there is a better, private urgent care facility at Rainbow and the 215 Freeway, across from Best Buys. We will never go to UMC Quick Care again.
And then there was the GROTESQUE over billing when she stayed at UMC's Pediatrics unit over two nights, after being slightly injured in a school bus accident. It was crystal clear to me that seeing she was insured, the staff physicians were doing everything they could to run up the bill and extend her stay AFTER the doctor assigned to her case ordered her released. The insurance company ended up paying for a whole extra day of b.s. which was clearly designed to pump up the bill.
My conclusion, after dealing with the UMC Hospital and UMC Quick Care, over a period of 6 years, is that anyone with insurance is insane to do business with them. The same is true as to anyone who can actually pay cash for their services.
I hope other people who have been ripped off by UMC Hospital's operations or by UMC Quick Care will come forward and contact this plaintiff's lawyer with their experiences.
they have to charge all that money to cover all those overpriced salaries. all those supervisors supervising each other. you want waste in the county buildings... UMC is it they are the prize catch. then comes metro, then fire departments.
Whether a patient is taken to a trauma center is dependent upon the certain field criteria which the emergency services providers are trained to assess. The criteria are set out in the Nevada Administrative Code NAC450B.770. In order to establish and maintain a Level I trauma center a provider must also meet certain critera. One of those criteria is that a trained trauma surgeon must be on premises at all times 24/7. The overhead to maintain a trauma center is high. This is due to the additional staffing and equipment needs necessary to give the type of treatment patients may need. Amazingly enough these folks do expect to be paid for their time.
The nurse evaluating the patient at the hospital is not the person who determines whether the patient meets activation criteria and is transported to a trauma center. It is possible that the patient may not have met certain criteria upon arrival simply because the treater did not have access to certain information used in the field such as the amount of intrusion into the passenger compartment of a vehicle in which he/she was riding. That's why the assessment is done in the field.
You want a fast diagnosis and a good outcome. That was what was delivered here. Unfortunately those demands come at a high price. I would suggest rather than suing the hospital you fork over a few more dollars for med-pay coverage on your insurance policy to cover the activation charge and send a thank you letter to the folks at the hospital who gave you world-class care.
Should have used Gwinn scholarship money to prop up UMC.
"He said that's because, under a typical auto insurance policy, money paid by the insurer to UMC reduces the money available for payment to the patient for her pain and suffering."
Exactly why you need to buy med-pay insurance. But Mr. Sbaih doesn't want to tell you that because he's "here to help you."
Why doesn't Mr. Sbaih mention the fact that caselaw in Nevada REQUIRES that the lawyer gets to take HIS contingency money right off the top BEFORE anyone else is paid, including the hospital and doctors. If there's not enough money left, well that's too bad he got his. Whose really ripping people off here?
People want UMC to be less of a burden on taxpayers, but here you have patients getting billed suing because in their opinion, they were billed too much. How do these bills compare to other hospitals' ERs in town? My guess is they are a bargain.
Me things bbtbrain protesteth too loudly.
Since when was stating facts protesting? You want to know that when you're in a serious accident that there will be adequate care facilities to take care of you....don't you? Well that costs money. CO what is your alternative? Maybe we'll just have the emergency responders drop them off at Bob Eglet's office for treatment? I'm sure he knows how to triage a potential head injury patient.
Watch them get away with a slap on the wrist and a token fine!
bbtbrain It is obvious that you recieve some personal benefit from these illgal activities. By the way regardless of who the emergency staff is the burden of the level of care and everything associated with the patient becomes UMC's responsibility when the patient is rolled in. Just how many layers of insulation do you want so UMC can continue these fraudulent practices anyway?
Your juvenile rant about Bob Eglet says alot about you and your principles and values. Thank God for attorneys like Sbiah and Eglet whp protect the public from illegal scams like this and fictional story tellers like you.
One look at Kathy silver and one wonders if in the end UMC and the public just has another Lacey. UMC needs to be taken over by private parties and the bloodsucking thieves who have had control of this laughing stock of a trauma hospital shoved to the curb of Charleston Blvd. along with thier dishonest supporters.
There are some rural hometown doctors here in the Midwest that would fit in with the environment of UMC according to this article in today's Las Vegas Sun. How many would be appropriate? They will be glad to entertain their better looking female patients after hours also whether in the pool, poolside, or in the room.
We have a vacant Alco store here at the present day home of the Thunderbirds and a wonderful dance team from the dance academy that can shake their booties; most of the dancers are doctor's daughters and the County Attorney's daughter, she teaches the youonger children dance routines.
We are looking for doctors who are willing to doctor and are willing to invest in the Alco building as a bona fide up-to-date doctors clinic. There is plenty of room for exam rooms, lab, X-ray, outpatient surgery, overnight stay hospital rooms, and plenty of parking space. There are several hospitals within driving distance that have remodeled their facilities that would welcome new doctors who are not looking for a place where they can play freebie basketball at noon and their daughters can shake their booties and enter the Miss Kansas pagent or may be be a show girl in Las Vegas at one of the stripper clubs. We also need a new radiologist who can read Xrays w/o exaggerating and reading into the films that that is not actually seen on the Xray. The hospitals available are Abilene, Clay Center, who uses a reliable group of radiologists, Salina Regional Center, Mitchell County Health Center, Lincoln County is building a new hospital which will be open 2011. If there are young doctors who are willing to reall contribute to rural communities we have the building for them to invest in and remodel to their liking.
Not really Homer. A patient has the absolute right to opt out of going to a trauma center. Of course they'll have to sign a document that it is against medical advice and he/she is responsible for any consequences. Check the Nevada Administrative Code. It's there. Homer you should spend a little less time consuming Duff beer and familiarize yourself with the laws your elected representatives are making.
Here, why don't you read the law yourself.
NAC 450B.774 Procedure when patient refuses transportation to center for treatment of trauma. (NRS 450B.120, 450B.237)
1. If a patient at the scene of an injury refuses to be transported to a center for the treatment of trauma after a determination has been made that the patient's physical condition meets the triage criteria requiring transport to the center, the person providing emergency medical care shall evaluate the mental condition of the patient. If he determines that the patient is competent, the patient must be advised of the risks of not receiving further treatment at the center.
2. If the patient continues to refuse to be transported to the center for the treatment of trauma, the person providing emergency medical care shall request the patient to sign a statement indicating that he has been advised of the risks of not receiving further treatment at the center and continues to refuse to be transported to the center.
3. The person providing emergency medical care shall inform a physician at the center for the treatment of trauma of the patient's refusal to be transported to the center for treatment before he leaves the scene of the injury.
4. As used in this section, "triage criteria" has the meaning ascribed to it in NAC 450B.814.