Mismanagement of St. Vincent Health (SVH) led to a host of financial and credentialing issues, some with broader legal implications.
The hospital struggled to properly credential its physicians and other health care providers with insurance companies since at least late 2021, making it difficult to collect payment for procedures and at times leading to more serious Medicare mixups.
Billing violations
Under former CFO Janet Petty and CEO Brett Antczak, SVH billed patients for services in a credentialed physician’s name when they actually saw someone who was not credentialed with certain insurance companies, as the hospital could not collect payment from insurance companies, including Medicare, without proper credentials.
The 2021 incidents surfaced when patients received bills in Dr. Lisa Zwerdlinger’s name after actually seeing an independent visiting dermatologist from Salida named Dr. Kathryn Echols, according to Interim CEO John Gardner.
This happened because SVH did not complete the credentialing process for Echols.
Credentialing a physician has two main steps. The first part is confirming whether a physician has the minimum medical skills required to perform the job, and the second is credentialing with insurance companies, said Zwerdlinger.
“That’s the piece that didn’t happen,” Zwerdlinger continued. “There were multiple physicians, not just the dermatologist, but multiple physicians that were allowed to see patients that were not credentialed.”
Zwerdlinger said...
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