Johnson City challenges hospital charges stemming from injury lawsuit

David Floyd • Updated May 13, 2019 at 7:06 PM

Johnson City resident Theresa Doty received medical bills totaling $204,196 from Johnson City Medical Center after a city-owned tractor collided with a vehicle she was traveling in on April 6, 2017, along Buffalo Road.

According to court documents filed in Washington County Circuit Court, the driver, Johnson City resident Ronald Weaver, lost control of the tractor and slid into the passenger side of the vehicle. Johnson City attorney Erick Herrin said the road was slick after a light rain and that the tractor’s tires did not sufficiently grab the pavement as Weaver was braking. Court records say Doty was 78 years old at the time of the accident.

After receiving treatment in the emergency room at Johnson City Medical Center and undergoing shoulder surgery, Doty is now suing the city for up to $300,000, according to a complaint filed in February 2018. But Johnson City is challenging the “reasonableness” of using Doty’s incurred hospital charges to seek damages from the city. Weaver and Johnson City are both defendants in the lawsuit.

“It has become a nationwide problem for what hospitals and other medical providers are doing as far as incurred (medical) expenses,” Herrin said.

The city filed a motion on April 29, 2019, claiming the hospital, which is part of the Ballad Health system, overcharged Doty for her medical expenses, which court documents say were ultimately satisfied by Medicare payments totaling $13,443.71. Johnson City Medical Center charged Doty $9,728 for the visit to the emergency room and $194,468 for the surgery on her shoulder.

“The defendants have submitted competent proof that, for reasons unique to medical providers, the Johnson City Medical Center finds it advantageous to generate billings for medical services that reside somewhere in the ionosphere,” the motion reads.

Marc Chapman, the owner of Chapman Consulting, a firm that conducts reviews of medical bills, argues in an analysis submitted with the city’s motion that, based on his calculations, the center should have charged $39,952 rather than $204,196 for Doty’s total medical expenses.

Chapman said in the report that hospital prices in the U.S. have risen disproportionately faster compared to their costs. Billed charges, Chapman wrote, have also “risen excessively” compared to the actual amount of money collected by hospitals.

“In fact, hospital charges are so disproportionate to the cost of care and the actual reimbursement rates that they do not come close to reflecting the true market value or the reasonable and regular rate for medical service, goods and supplies,” Chapman wrote in the report. He said Johnson City Medical Center follows the same pattern.

Insured patients rarely pay full hospital charges, as their health plans include negotiated discounts.

Chapman said in the report that Johnson City Medical Center on average collects 16.4% of the money it bills to patients. “This is what the question becomes: Why does the hospital play this game of these huge charges for which they do not get paid?” Herrin said.

Ballad Health officials declined to comment.