Hospital Billing Fraud

Kimber K asked:

as per our agreements, I am to pay for these services (medical insurance, dental insurance, etc. and child care) first and then he is to reimburse me for these services, not write a check directly to these services. The checks for med/den he leaves the “Payee” line blank, I write my name on the line and deposit these checks, but on the child care reimbursement check he filled out the name of the child care facility. I wrote my name next to it and deposited this check into my account. The bank accepted it, no big deal. I pay all my bills through bill pay. All the info is there, no checks to chase, or fill out, and I can better tack all my expenses. Now we are up for custody court hearings and his atty is claiming I committed check/bank fraud. Any thoughts on this???

physician billing

happywanttobmommy asked:

Ok, I know most of the answers I’m going to receive are “go to jail, you’re dumb, etc”. Please, I need help! I’m a 21 year old female college student (graduating with my BS on May 11th). I really messed up. My school schedule has restricted me to where I can’t work anymore. My father was paying for my apartment and bills and he recently became sick and has spent all of his money on medical bills. For the past few months, I’ve been writing checks from one of my bank accounts to the other and withdrawing the money to pay my bills. I honestly just thought I would have 2 eventually pay it back. Now I realize it’s illegal. My bbt account balance is negative $1800, Wachovia -$1300 and Credit Union -$1600. (about 1000 is overdraft fees total from all) I know this is a lot of money! My banks obviously have figured this out and I have no way to pay it back. I can’t even get approved for a loan. I don;t know what to do. Please give me advice. I know i messed up but I don;t want to ruin my future
I now have a job and I start tomorrow. However, I only get paid once every two weeks. I don’t want to be charged criminally in the meantime. I’m so stressed out. I can’t believe I did this. I honestly didnt realize this was illegal. I just thougt at most I would get an even worse credit rating.

medical billing specialist

malonz19 asked:

Our PPO insurance has extremely high annual deductible & relatively high co-pay (we are seniors, my spouse is self-employed – it’s the only way we can afford any insurance at all).

My spouse had colonoscopy done late last year. Our insurance sent authorization to the gastroenterologist doctor who was to perform procedure. This doctor scheduled procedure at a day-surgery center. Insurance did not issue pre-authorization for this surgery center – only to the doctor.

On the date of service (DOS) – our credit card was charged $2000 as a pre-payment.

When the bill from the day surgery arrived – it was for $6800 less the $2000 we prepaid = $4800. This is apart & separate from the co-pay charges by the gastroenterologist & the anesthesiologist.

Based on the Explanation of Benefits (EOB) from our insurance provider (in Feb 2008) – disallowed charges was over $2300, and allowed charges was only $2865 – all of which was chargeable to us. The insurance wasn’t going to pay anything – the burden is all on us (don’t ask why).

Here’s the problem:
I found out from our insurance that at the time of service – this surgery center’s contract w/ insurance company had expired. IOW, they were NOT contracted with our insurance when they took my spouse as a patient – and they did NOT REVEAL this info to us. How would we know that? The gastroenterologist may or may not have known it either that the surgery center’s contract with the insurance had expired. If he did, why would he send us to that facility?

Therefore, this surgery center’s invoice stands at $4800 (which is $6800 less pre-payment of $2000).

I had asked for help from both our insurance customer service dept. & insurance broker – and they both said that the surgery center could not, by law, have turned us away even though our insurance wasn’t contracted with them on day of service. But why would they have scheduled us in the first place – if they knew that their contract has EXPIRED, was under re-negotiation at that time, and they had NO firm contract with our insurance?

I know I should have talked to the surgery center and tried to negotiate the amount down – as low as possible.

I have been in touch with them 2 – 3x in March – April 2008 (to coordinate the $2000 payment we made which did not show in their first invoice). But I have not been in touch since then – I am very upset, and at the same time I get very very anxious (just thinking about calling them) because I don’t know how to approach this situation such that I could show them that they seem to have acted with malicious intent & possibly even fraud. I want to put them on the defensive – instead of us being on the defensive.

Has anyone experienced something similar – and what did you do? I urgently need rational & intelligent advice. I am afraid they might have referred us to a collection agency already – there is an unidentified computerized message on our phone asking us to call a certain number – without identifying who they are..

HELP!!! Thank you so much in advance.

physical therapy billing

meihsia asked:

a debt collector keeps calling me and asking me to pay a medical bill (they said the service date as in 2002….. 4 years ago???) through telephone but refuse to send me the statement.

I really am not sure what that bill is about and I need to look at it first before I pay. they’ve kept calling for a month every other day …

I surely will pay the bill if that’s not a fraud call and I really don’t like they call so often. But I definitely will not pay if I don’t see the statement. What can I do?

medical billing specialist

freedom_rulz@sbcglobal.net asked:


I stayed at a hospital for three days in November. I have a $1500 deductible which I have not met yet. My EOB (Estimation of Benefits) said I may owe $2200 (out of $6000) — most of that $2200 includes my deductible and co-insurance. However, when I recdived the bill a month ago (around December 15th), it shows that I owed only $58 and, according to the itemized bill, most of the $2200 I owed was written off. Is this possible? Or does this sound like an accounting mistake? (My mother-in-law, who knows a lot of people who work at that hospital, will be checking it out this week.)
1. I’ve had outpatient procedures at this hospital and I can tell you that they have not written off a huge amount like this — some, but not a huge amount.

2. About two years ago, my dad had gallbladder surgery at a different hospital. Out of the $25,000 he owed, insurance paid $15,000, but he ended up owing only $1,000 because the hospital wrote the rest of this off.

3. Do hospitals tend to write off big bills that are processed towards the end of the year — for tax purposes?
I am on Blue Cross/Blue Shield BlueOptions (PPO) with a $1500 annual deductible. They have a contract with this hospital.

medical billing association