By CARRIE JOHNSON and KRIS HUNDLEY

© St. Petersburg Times, published May 17, 2001

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INVERNESS -- Betty Lefevers was puzzled by the $5,900 bill sent by her hospital. She thought most of those expenses were covered by her health insurance.

So Lefevers sent $200, the sum of her co-payment, hoping that would get the hospital off her back.

It didn't.

The hospital, Columbia North Florida Regional Medical Center in Gainesville, contacted a collection agency.

Panicked her credit rating would be ruined, 69-year-old Lefevers set up a payment program. But after sending $50, she refused to pay any more.

"I just happened to know that this was not a fair thing, that it was not legal," said Lefevers, who had worked as a nurse at Citrus Memorial Hospital.

Now Lefevers is filing a class-action lawsuit against HCA-The Healthcare Co., which owns North Florida Regional Medical Center, claiming she is the victim of a practice called "balance billing."

According to the lawsuit, insurance companies give certain hospitals "preferred provider status," which means the company will send insured patients to the hospital in exchange for a discount in medical services.

However, after the medical procedure is completed, hospitals will sometimes attempt to recover the amount of the discount by billing the patient, not the insurance company. That's "balance billing," the lawsuit states.

In Lefevers' case, her health insurance company, RISCORP Health Care Plans Inc., had a partnership with North Florida. The hospital agreed to give her a 20 percent discount on her $28,868 medical bills, the lawsuit states.

But the hospital later tried to charge Lefevers for that 20 percent, which worked out to exactly $5,973.

HCA owns 179 hospitals nationwide and nine in the Tampa Bay area. Jeff Prescott, spokesman for the Nashville-based company, said HCA has not been served with the lawsuit and could not comment on the allegations.

John Yanchunis, Lefevers' attorney, said his firm has represented many people who have been overbilled in a similar manner. He thinks the number of victims could stretch into the thousands, and the damages from the lawsuit could be in the tens of millions.

The lawsuit seeks to represent all people who were "balance billed" by HCA for amounts already covered by their insurance companies between 1997 and the present.

The lawsuit, which will be filed today in Citrus County, alleges breach of contract, deceptive and unfair trade practices and failing to deal in good faith.

HCA, formerly known as Columbia/HCA Corp., has been the target of wide-ranging government investigations into its operations for the past several years. Two of the company's executives were found guilty of Medicare fraud following a trial in Tampa's federal court in 1999; they are free pending appeal.

Following three years of negotiations with the U.S. Justice Department, HCA agreed to pay $745-million to settle several civil claims and another $95-million as a criminal fine. Still outstanding is a settlement agreement on charges that HCA submitted false cost reports and paid kickbacks to doctors. The Justice Department has estimated that the two practices cost the government more than $640-million.

If HCA defrauded the government, then what's to stop them from defrauding consumers, Yanchunis asked.

"It's the next logical step," he said.

Most people who have been overbilled simply pay the money, or get Medicare to pay the money, to put an end to the hassle. But typically, if a patient refuses to pay, the hospital backs down, Yanchunis said.

But in Lefevers' case, it didn't.

Lefevers was seriously injured in a car accident in the fall of 1996. She received treatment at North Florida Regional Medical Center in Gainesville from Jan. 22 to Jan. 26, 1997.

Lefevers said her training as a nurse led her to believe the bill from HCA was suspicious. She said she is outraged a health care company would try to take advantage of patients her age.

"Especially when we've worked hard all of our lives to keep our credit ratings good," she said.

Lefevers said it was her desire to help others who may have fallen victim to this practice that motivated her to file the lawsuit.

"I hope that if this is as widespread as I think it is, then a lot of people are going to be getting some relief."

St. Petersburg Times

-- Anonymous, May 17, 2001