Dozens of patients have lodged complaints against a medical clinic in Carrboro, alleging that the clinic’s owner overbilled them, filed multiple insurance claims for a single visit and hired debt collectors to pursue the patients for the bogus bills.
The complaints share a common story: Patients paid their co-payments during clinic visits. Months or years later collection agencies sent letters, warning that their credit ratings would suffer if they didn’t pay up, even though their insurance providers had already settled with Xiao McLinton, the owner of Carrboro Family Clinic.
In some cases, the insurance companies had already reimbursed McLinton. In other cases, she submitted claims after the permissible amount of time allowed according to McLinton’s contracts with them, or told patients that the services they had received months or years earlier were not covered.
The North Carolina attorney general’s office is currently investigating the clinic, said spokeswoman Laura Brewer.
McLinton has left a trail of patients with damaged credit ratings, but she denies any wrongdoing. In an interview with The News & Observer, McLinton said she continued submitting claims for the services patients received when the computer system she uses for billing, Kareo, did not show that she had been paid for the services. After she has been paid for a service, Kareo will not allow her to continue rebilling, she said.
Several former employees who have since left or been fired did not bill correctly, McLinton said.
“I did get paid after I submit and submit … if you don’t pay me, I will keep sending them,” McLinton said.
McLinton, a family nurse practitioner, also said that insurance companies do not pay her enough for the medical services she provides, especially compared to the amounts doctors are paid.
“They adjust a lot, they didn’t pay me well,” McLinton said. “They take advantage of me, and I do more than (a) doctor (does).”
Blue Cross Blue Shield reimburses medical providers according to the amounts negotiated in a contract between the insurance company and the provider.
Charles Brownell visited the clinic Dec. 30, 2013. It was conveniently located several miles from his home in Chapel Hill and he wanted to support a new business in the area, he said in an interview. The original bill for the treatment provided by McLinton was $168, and Brownell said he paid the required co-payment of $30.
Brownell shared his insurance records with The News & Observer, as well as his correspondence with the attorney general’s office, McLinton and a debt collection agency.
McLinton submitted six claims between May 31, 2014, and Dec. 13, 2014, for the services she provided Brownell, according to his insurance records. The amounts ranged from $168 to $198.
Blue Cross Blue Shield, Brownell’s insurance provider, denied all six. Some were denied because the service was not covered for either the primary diagnosis or the service codes listed. Others were denied because the claims duplicated previous ones.
The total bill was $168, according to Brownell’s Explanation of Benefits on Dec. 13, 2014. Blue Cross Blue Shield reimbursed McLinton $88.78, and McLinton was permitted to bill him for up to $45. To settle the $15 balance remaining after the $30 co-payment, Blue Cross Blue Shield told McLinton to resubmit the claims with the proper code.
But after Blue Cross Blue Shield paid $88.78, McLinton submitted 10 additional claims over the next 11 months – all in the amount of $235. Lew Borman, a spokesman for Blue Cross Blue Shield, said McLinton had filed 16 claims for Brownell’s single visit on Dec. 30, 2013.
“Multiple claims filed like this are unusual. It’s a small number of claims that are sent back,” Borman said. “It’s not common.”
Sixteen months after Blue Cross Blue Shield had paid McLinton, Brownell began receiving notices from Financial Data Systems, a Wilmington-based debt collection agency, indicating that he owed the clinic $220 for services they provided, Brownell said.
“I was surprised when this began happening,” Brownell said. “If I get a bill, I pay it.”
He wrote McLinton saying that he believed she had been paid for the services and there was no outstanding balance. McLinton wrote back and said she had submitted claims for the services and was turned down. She asked for his help with collecting payment from Blue Cross Blue Shield.
Brownell called Blue Cross Blue Shield and discovered the company paid McLinton on Dec.14, 2014, yet she continued submitting additional claims.
Brownell said this has damaged his credit. Though he said he recently received a letter from the clinic indicating it had informed Financial Data Systems that Brownell had paid his bill, his credit report has not changed. He is not looking to buy a house or a car, a purchase that would involve his credit score, but it is still troubling, he said.
“I don’t owe her anything,” Brownell said. “The charge will stay there until I die, because I’m not paying a bill I don’t owe.”
McLinton said Blue Cross Blue Shield and other insurance companies “mislead” their patients. She no longer works with Financial Data Systems, she said.
Several patients said they attempted to contact McLinton by telephone, email or letters and she yelled at them on the telephone, did not respond or sent handwritten notes that were difficult to read.
In a complaint submitted to the attorney general’s office, Dane Eubanks, a former patient, said during a conference call with McLinton and Blue Cross Blue Shield, McLinton “yelled at the BCBS Rep and then put us on hold before we realized that she was not picking the phone back up.”
Brooke Simmons, who visited the clinic in 2011, had a similar experience. Five years after her visit, she started receiving notices indicating she had an outstanding balance, though she paid her co-payment at the time of her visit, Simmons said.
She called the clinic and said that she would pay if she could get an itemized bill.
“(McLinton) cut me off,” Simmons, who now lives in Charlotte, said. “She wouldn’t let me talk and said she couldn’t deal with patients who aren’t paying. She said she didn’t have time to send me a bill.”
Simmons attempted to verify her personal information on file, but McLinton hung up, she said. Simmons called back to leave a voicemail threatening to report the clinic to the attorney general’s office, but then the phone was picked up and placed off the hook, Simmons said. She called back and found that the line was busy.
“I was shocked,” Simmons said. “I was willing to pay and give her my money, but I needed a bill showing the services.”
Simmons filed a complaint in December with the attorney general’s office, which told McLinton she had 15 days to respond, Simmons said. Several weeks later she checked her bank account and the charge had been dropped.
“My credit score went up by 30 points,” she said.
Madison Iszler: 919-836-4952; firstname.lastname@example.org