Posted and filed under Fraud, Healthcare, Payers.

Should a patient who suffers a medical condition as a result of their treatment have to pay for the resulting treatment? Should the financial responsibility go to their insurance or the facility that caused the problem?

Before everyone starts hitting the comment button and mentioning hospital-acquired conditions, let us set the stage for the scenario:

The patient is receiving chemotherapy for blood cancer. While receiving the treatment, the needle delivering the chemotherapy becomes dislodged and the chemo spills on the patient’s arm. Chemo is toxic, and as a result of some chemical reaction, it burns your skin terribly when applied topically, but not when it is in your body. The patient suffers some pretty severe burns that require a course of antibiotics, a topical burn cream, and a few other treatments.

The treatments do not work, and now the patient has to be seen by a plastic surgeon for debridement and possibly a graft. Insurance claims, copayments, and the like, all adding to the financial burden of needing the chemo. All of this is piled on top of the psychological effects of dealing with the injury on top of the chemo.

It is not a hospital-acquired condition, so the facility is not on the financial hook for this. It is not uncommon for this to occur, and the patient has now had a port inserted to prevent this from happening again. In some regards, we often forget about the collateral consequences of the care we receive that is intended to make us healthy.

We have been unable to find any statistics to reflect costs, but we would have to assume that, as with most things in the healthcare world, the costs are high. We wanted to highlight this in our blog, not so much as a discussion of fraud, waste, and abuse (which as everyone who reads, knows this is our passion and what all of our retired OIG agents talk about nonstop), but as just another area of where the healthcare system’s financial implications are monumental.