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 !!

***
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.]

***
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

~*JaYDens PrETTy MoMMy*~ asked:

ok i saw this add on the penny-saver, that said comouter jobs i called. and its a training course for medical billing n coding. its 2 weeks long n its from 1-5pm mon-fri. n they have job placement as well. he tol me they place u in either hospitals or a dr office. u get ur diploma and Two certificates in microsoft word and excel and the other ni medical billing. the fee is 2250 but i dnt start paying them until im working already n its in payments of 99$ a month,. how does this sound to u,? and the reason im actually looking into this its cus they said in this feild ill start off getting paid 15$ an hour n im 18 n a have a 4month old baby so i need the job n money. should i go for it?? or do u think its a scam?
10 minutes ago – 3 days left to answer.
Additional Details
8 minutes ago

the outside door to that building said its called ” Gendarme Institute” can sumone look that up for me, but i think its a financial aid type of thing
8 minutes ago

oh n it says “computerized Medical Billing
4 minutes ago

i dont have to pay anything up front> i dnt pay a single dime until ive gotten my certificates n they get me a job n have my first pay check!

health care billing fraud

Cassandra asked:

ok, first of all I work for a doctors office as a receptionist. a while ago I was on myspace looking at one of my friend’s profile, and you know how one profile leads, to another, and so on. Well, I see one of my patient’s profile ‘jane doe” and i notice that she has a different name, then i realize that she has a twin sister but a fatter version claims to be “janice doe”

point is…i think my patient “jane doe” is using her obese twin sister;s (janice doe) insurance!!

what do i do? should i report my suspicions to the insurance company or my boss? but im also afraid that my boss might not care in fear of loosing money….i would

anesthesia billing

chattterus asked:

Here is how individual insurance policies typically work:

1)Every year insurance companies create a new policy. For the next year they encourage people to sign up, then stop offering that policy to new people after one year. All of these people share the medical costs of everyone in the policy.

2) For the next half dozen years they encourage healthy people to upgrade to new policies. This leaves only the sick sharing medical expenses and the insurance premium goes up quickly.

3) A dozen years after each policy is made no one can afford the premium because everyone in the policy is sick and has major expenses. All of the ill people then lose their health insurance.

4) Now that the ill people have been filtered out from the healthy people they can’t get insurance and are left to die by health insurance companies that could care less.

My mother was one of the people filtered out when they sent her a sixteen thousand dollar premium bill for the year on a policy she joined over 15 years ago. She would like private insurance, but is turned down by every insurance company. She has to rely on government handouts to pay her medical costs.

My opinion is the goal of health insurance is to defraud anyone who is has an illness. Do you agree?

hospital billing

j2rev asked:

I have health insurance through my employment and another insurance through my mom’s. I just had a procedure earlier today and asked the registrar upfront before the procedure of they could co-bill both insurances at the same time, and she adviced not to, and adviced me to let all my doctors know that i have another insurance, and that i would be in big trouble. i really am confused on what’s going on. can anyone help me please? thanks
I appreciate all the info guys. the thing is that I use my mom’s insurance as my primary since all the facilities and providers I see and get my procedures done are under the same name, and my mom works in a hospital under the same name.
I guess what I really want to know is what I need to do at this point to avoid getting into trouble.
I remember giving BOTH insurance information in one procedure way back (blood draw) but still paid the same co-pay amount for my mom’s insurance.

medical collections

P asked:

Hey everybody. I have a friend who is trying to get health insurance but has run into a roadblock. This friend has never had insurance and has therefore paid for any doctors visits with cash. She lost all of her records in a storm (this is Florida) and therefore doesnt know how to answer the questions on the insurance application. She isnt a law breaker, just wants to know how to proceed to avoid breaking the law. Thanks a lot for the input

medical billing management

redheadedstepchild asked:

My ex wife was given her maiden name back by court order during our divorce. Yet, two months after the divorce was finalized, she filed a claim on my Health Insurance using her former “married name” to receive health coverage.

Is this Insurance Fraud??

No insurance coverage was provided for in the divorce decree either.

medical billing online

Bob asked:

One estimate states that fraud and abuse cost Medicare and Medicaid about $33 billion each year. The government cannot run these programs efficiently, so why is there so much interest in going to Universal Healthcare?

We also see how the government runs the Veterns Administration with the current problems in the news. Is this really what everyone wants?

These articles show the idiots that got caught. How many never get caught? Don’t you think universal healthcare will be the same?

Fraud Articles:

http://www.ncpa.org/health/pdh5.html

http://hosted.ap.org/dynamic/stories/M/MI_MEDICARE_FRAUD_MIOL-?SITE=MITRA&SECTION=HOME

http://www.philly.com/mld/philly/news/local/16840155.htm

http://www.cbsnews.com/stories/2003/04/16/health/main549643.shtml

http://www.signonsandiego.com/uniontrib/20070215/news_1n15region.html

anthonyinkc – I have not see you comment on this info. You said in another question that these programs where so efficient. Thus this question is really aimed at your last answer.

physician billing fraud

pantagruel asked:

Insurance only covers you if you or your employer pays for it.
When you get so sick that you lose your job,the ins. stops as well ! All you’re covered for, is just the original health problem. Don’t come down with anything else ! You won’t be covered !
Unless you are very wealthy, you’ll have to go on Medi-Care or Soc. Sec. ! Then you can have only 1 car, 1 house,and no more than $2,000 in the bank ! If you go over the $ limit,you lose benifits ! So if you get cancer and live,…you will never be able to get ins. again.! Don’t get sick or break a bone..you’re not covered ! Does that sound fair? Everthing you have worked for and saved up,will be GONE ! It’s a scam !
how do you pay for COBRA? When you’re on disabity you can’t work,and you can’t have much in the form of assets.We’re living it !
h ow is cancer and never being able to get ins. again, just sreading DRAMA? This is my life experience. Death is a drama !
The way S.S. is set up, you’re better off if your NOT married.

physical therapy billing

flowerpot asked:

A. There has been a case of child abuse. B. There has been an instance of health care fraud C. A patient has shown symptoms of domestic violence victimization. D. A patient is unhappy with something the doctor did or failed to do.

hospital billing policy