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Stuart G

(38,359 posts)
Sat Dec 7, 2019, 03:45 PM Dec 2019

Where All Frauds Are Legal."Welcome to the weird world of medical billing."NewYorkTimes:

https://www.nytimes.com/2019/12/07/opinion/sunday/medical-billing-fraud.html
______________________________________________________________________________________
By Elisabeth Rosenthal
Ms. Rosenthal, a journalist and physician, is a contributing opinion writer.
Dec. 7, 2019, 2:00 p.m. ET
_______________________________________________________________________________________

Much of what we accept as legal in medical billing would be regarded as fraud in any other sector.

I have been circling around this conclusion for this past five years, as I’ve listened to patients’ stories while covering health care as a journalist and author. Now, after a summer of firsthand experience — my husband was in a bike crash in July — it’s time to call out this fact head-on. Many of the Democratic candidates are talking about practical fixes for our high-priced health care system, and some legislated or regulated solutions to the maddening world of medical billing would be welcome.

My husband, Andrej, flew over his bicycle’s handlebars when he hit a pothole at high speed on a Sunday ride in Washington. He was unconscious and lying on the pavement when I caught up with him minutes later. The result: six broken ribs, a collapsed lung, a broken finger, a broken collarbone and a broken shoulder blade.

The treatment he got via paramedics and in the emergency room and intensive care unit were great. The troubles began, as I knew they would, when the bills started arriving.

I will not even complain here about some of the crazy high charges: $182 for a basic blood test, $9,289 for two days in a room in intensive care, $20 for a pill that costs pennies at a pharmacy. We have great insurance, which negotiates these rates down. And at least Andrej got and benefited from those services.

What I’m talking about here were the bills for things that simply didn’t happen, or only kind-of, sort-of happened, or were mislabeled as things they were not, or were so nebulously defined that I couldn’t figure out what we might be paying for.

To be clear, many of the charges that I would call fraudulent — maybe all of them — are technically legal (thanks sometimes to lobbying by providers), but that doesn’t make them right. And no one would accept them if they appeared on bills delivered by a contractor, or a lawyer or an auto mechanic. There were so many of these charges that I came up with categories to keep track of them:

(rest of story at link above..)
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Where All Frauds Are Legal."Welcome to the weird world of medical billing."NewYorkTimes: (Original Post) Stuart G Dec 2019 OP
Was in the ER twice this week and admitted once. Waiting in dread for the bills. Midnight Writer Dec 2019 #1
oh dear Skittles Dec 2019 #3
Yes, on the mend and doing well.. Now mostly worried about the bills. Midnight Writer Dec 2019 #4
it's crazy, it is legalized extortion Skittles Dec 2019 #2
+1 dalton99a Dec 2019 #6
Medicare for all russ1943 Dec 2019 #5
The scam is at all levels of the system! lanlady Dec 2019 #7

russ1943

(618 posts)
5. Medicare for all
Sat Dec 7, 2019, 09:50 PM
Dec 2019

From the perspective of the current issue regarding Medicare for all does this author and DU’rs here see this medical billing problem as more or less likely under the MFA?

lanlady

(7,133 posts)
7. The scam is at all levels of the system!
Mon Dec 9, 2019, 09:10 PM
Dec 2019

My allergist/asthma doctor systematically bills my insurance company for breathing tests I didn't take. The basic charge for an office visit is $350 to take my blood pressure and get a five-minute consult with the doctor. My insurance pays $200 (outrageous enough) and I get stuck with $150 just to have the doctor do a quick check with a stethascope and write me a script for Prednisone. Nothing else.

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