Editor's Note: Floridians are paying a lot of money for health insurance, but we’ve been listening to our viewers. Many of you are very unhappy with your coverage. At ABC Action News, we want to take action for you. Has your doctor prescribed treatment that your insurance company denied? We are digging into the problem of outrageous denials. Our special coverage is called Patient No More. We are investigating why claims are denied and provide useful information that gives you the best chance of getting your medical claim approved.
"I think people need to speak up"
A veteran went into rehab in Sun City Center after a knee replacement and came out with a more than $19,000 bill.
Roger Brown received that bill nearly a year later. When he received that bill, he was then told the $19,000 charge would not be covered by Medicare.
“I think people need to speak up and make things happen instead of just sitting back,” Brown said.
That’s what prompted him to contact the ABC Action News I-Team and share his story.
The 81-year-old disabled Army veteran served our country before fighting to get the customer service and support he needs to combat a bill that took his breath away.
“I got a bill, which I showed you, for $19,453.52,” Brown told I-Team Reporter Kylie McGivern. “I didn't know what to do! My heart just stopped.”
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Brown had an operation for a new knee in February 2024.
“So I came home and I was having a little bit of problems. And my wife, not being a nurse, she was having a problem getting up at night, you know, to help me go to the bathroom,” Brown said.
Brown called his doctor and was admitted to St. Joseph’s Hospital South in Riverview. On the second day, Brown said a nurse told him that they made an error in coding.
“And she said, we're going to have to keep you two more days for Medicare to kick in,” he said.
Brown then went to Palm Garden in Sun City Center for rehab. He stayed for 30 days. The rehab was covered, but not his stay.
“I’ve never got something like that from Medicare saying you've been rejected, you know, nothing like that,” Brown said.
Then, eight months later, he received a letter from Palm Gardens saying his payment is past due.
“Private payments are due fully by the 10th of each month” Brown said, reading from the letter.
“I said surely this has got to be a scam letter. So I took it to Palm Garden and I handed it to her, it wasn’t signed by anybody, nothing,” Brown said.
He was told he is responsible for the payment.
"Don't pay 'em a dime"
Brown said the woman working at Palm Garden told him, “Medicare will not pay this because of the coding error at the hospital. And we have tried working with the hospital to move dates to take care of this, and they will not work. So you got two parties trying to work and none of them want to work together and it's got into this. And I'm left out on an island, owing $19,000,” Brown said.
Brown said he had no intention of making a private payment. Instead, he made an appointment with his doctor.
“He says, ‘Roger, don't pay ‘em a dime.’”
Then, Brown called the Medicare Fraud Hotline.
“They said this is very important that we take this up the ladder,” Brown said.
"Hotline complaints matter"
That ladder — leads to Dan Hoy, the director of hotline operationsfor the Office of Inspector General for the U.S. Department of Health and Human Services.
The hotline accepts tips and complaints about potential fraud, waste and abuse within HHS programs like Medicare.
“I’ve dedicated my life to public service," Hoy told the I-Team. "I find it extremely rewarding taking care of Medicare beneficiaries, they’re some of the most vulnerable population in our country and they deserve quality healthcare, and they deserve not to be taken advantage of."
On average, Hoy said the hotline receives about 140,000 contacts a year.
“It’s my team that reviews them, triages them, and makes sure that they get to the appropriate place for further review by senior agents and senior investigators," Hoy said.
Those contacts include Brown.
“He absolutely did the right thing in reaching out. And I’m so thankful that he was able to get that resolved," Hoy said, when the I-Team shared Brown's story.
“Hotline complaints matter. Over the past five years, it’s led to over 2,200 case being opened by our office of investigation and has brought back almost $500 million in monetary recoveries," Hoy said. “If you see something that doesn’t look right, please report it. As soon as you see something, report it to the OIG hotline.”
"Your new balance is a charge of $0"
“I’ve always been a fighter, I said, I'm not going to take this lightly,” Brown told the I-Team. “I’m fighting back. And that's the reason I called you.”
After Brown’s own fighting and a push from the I-Team, contacting Medicare about his case, Brown received a letter.
“You are not liable for these charges,” Brown read from the letter. “Your new balance is a charge of $0.”
“I was elated! I was elated, you know, it’s amazing,” Brown smiled. “Just a little bit what your fine station has done, you know, to do this is just unbelievable. What a relief!”
The I-Team contacted Palm Garden in Sun City Center multiple times to discuss Brown’s bill. No one returned calls or messages.
- If you suspect fraud, waste or abuse related to your Medicare bill, contact 1-800-HHS-TIPS (1-800-447-8477)
- File a complaint online
- For issues related to your Medicare policy, coverage, billing claims or appeals, file a complaint
at Medicare.gov or call 1-800-MEDICARE
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