By contrast, four nearby hospitals billed more than twice as many cases of pneumonia with complications as of the complex infection - 263 to 117.

Under the plan, hospitals would bill the Federal Government directly for treating illegal immigrants, Mr. Gingrich said.

For more than a year the hospital billed the patient for payment and threatened to send his name to a collection agency.

In a reformed system neither hospitals nor doctors inside a prepaid plan would bill anyone.

The hospital billed patients $141 million in 2010, and collected $76.5 million.

The biggest reason for improper payments in 1998 was that doctors, hospitals and others billed Medicare for services that were not medically necessary.

The hospital billed $6,275 for the outpatient procedure, and she paid 20 percent, or $1,255.

The hospital billed $3,132, and she paid 20 percent, or $626.

Mr. Twitchell was incensed to learn that the hospital had billed the Government $417 for those services.

A more significant shift was evident in the way hospitals billed patients.