Hospital Billing Fraud

Spock (rhp) asked:

My wife’s HMO just sent us a summary statement of medical care bills and payments for all of 2008.

You tell me — doesn’t this amount to grand fraud?

1. total charges [excluding double billing caused by HMO delaying for months] 33,343.80

2. Allowed by contract [also includes 437.37 that hasn't yet been been ruled as allowed or denied] 8312.78

In other words, the amounts “billed” by the hospitals, lab operations, physicians, clinics, radiologists, etc. were FOUR times the amounts they’d actually agreed to accept as full payment from the HMO.

Now, if you didn’t have an insurance company bargaining for you, the hospitals, et al, would be trying to collect FOUR times as much from you as they really expect to get, and really “should” get.

FOUR FREAKING TIMES AS MUCH !!

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Aside: for everyone who asks in these forums about paying their medical bills — the bill is a fraud. Provider never expected to get anywhere near that much. Don’t pay it. Offer them far less — it’s all they every expected to get anyway.

[The public hospital was the worst -- billing at FIVE times the amount they'd agreed to accept. By comparison, the regular doctor was only billing 1.6 times the allowed amount. Specialists were billing from two to four times the amounts they'd agreed to.]

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Now, if your banker was billing you for FOUR TIMES as much interest as he actually expected to collect, you’d call it fraud, wouldn’t you?

And isn’t it just as much a fraud when the public hospital district bills at FIVE TIMES what it expects to get — and then sues the poorest people [who don't have insurance] for the WHOLE FREAKING AMOUNT?

Ye Gods above — no wonder unexpected medical expense is the leading cause of bankruptcy in America. Most of the bills are frauds from moment one.

physician billing fraud

chris k asked:


My son was hospitalized in 05 and the bills were sent to the ins. co. with me (his mother) as the pt. My ins. co started to pay but then received bills in my sons name. There were many double billing errs. After some time, this mess was rectifyed. My ins. company paid the allowed amts on all hospital and doctor bills and we paid our co-pay.

Time passed, about 8 months, when my son got a call from a collection agent stating he owed more money. When we attempted to get a copy of the billing statement the MD office stated that it had been sent to collection; we should contact them. We have made numerous calls and are always put on hold for an extended perior of time or sent to a full voice mail box. We would pay the amt. if we only knew what we were paying. What recourse do we have? Chris

medical billing and coding