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Audit: UIHC missing $11 million

BY EMILY BUSSE | APRIL 29, 2010 7:30 AM

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An internal audit identified $11 million in missing patient charges in areas of University of Iowa Health Care, officials told the state Board of Regents on Wednesday.

The audit report deemed the missing billings — which one regent said he thinks were caused by human error — to be a high priority.

UI Hospital and Clinics CEO Ken Kates told the regents he was extremely disappointed with the audit’s findings, which come less than a year after a majority of the UIHC’s units switched to a new patient-record computer system.

“We’re determined to figure out why the failure occurred,” Kates said.

The problem most likely started in November 2009, when bills for services in the UI heart and vascular areas were not entered into the system, according to the audit.

After the discrepancies were identified this year, all of the missing charges were entered into the system.

Hospital officials mailed the missing bills to patients, and the facility has received some of the payments, officials said. The missing $11 million should be completely collected by September, they said.

The entire hospital takes in about $235 million in gross charges monthly.

Regent Robert Downer, who met with UIHC officials Monday, said he was “very pleased” with their answers to his questions and was happy they were taking the situation seriously.

Downer said he thinks the billing errors were caused by human error and not as a result of the new computerized records system, called EPIC.

This year’s audit was the first since the EPIC program — an electronic records system that has caused difficulties in other clinics — was implemented at the hospital.

Downer speculated the incident could have occurred when “someone involved in the billing process essentially lost control over entering the charges in the system.”

The area in which the missing charges were found was operating on a hand-billed system, he said.

Kates also denied that computers caused the error. He said officials cannot determine the true cause until further analysis is completed, and it “appears we did not have the necessary front-end and back-end” administration in place.

Last week, officials assembled a “root-cause” team to identify how the incident happened; they said they hope to have the results soon.

UIHC officials said they had specifically requested an audit in that area, but not because they thought there was a problem.

“[Requesting an audit] is not unusual,” said Jean Robillard, the UI vice president for Medical Affairs. “We go proactively. We don’t wait.”

The audit also listed poor documentation of patient vitals and insufficient oversight of the billing staff as issues.

While Kates and other officials said they were confident the missing charges would be completely recouped, they did not deny it was a failure.

“We don’t like when they find things like this,” Robillard said. “Nobody does.”

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