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 !!

***
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

jdeekdee asked:


HMO ins. co told me I could take my child to PCP (primary care physician) that is not in their network (none in our area). Ins. co said we just pay $10.00 above co-pay.
We went to this doctor many times, ins. paid this dr. each time. We paid the $10.00 each time. This dr. referred my child to go to hospital.
Now ins. is not wanting to pay for this hospital bill cause doctor who referred this is not in their network.
I talked to ins. and they said they should have never paid these dr. bills and that is was their mistake, so I wouldn’t have to pay the hospital bill and that they will.
Now the ins. co is saying they don’t have record of that person telling me that.
And they said they never told me I could use out of network dr. so now they are not paying the hosp bill.
There is a person from ins.. co who is working with hospital. I called ins. co. to talk to this person. Ins. said there is no record of this person corresponding with the hosp..
HELP!!!
question to everyone here- isn’t the ins. co violating their own policy by telling me I CAN go to a dr. out of network, and then they paid for this dr?
Can’t I file an appeal or complaint because of this? It just don’t seem right that they can do this wrong, but then I still have to pay the hosp bill.
TO SCORPIO9, HOSP TOLD ME THAT INS DID PAY, DOES INS HAVE TO SEND ME DOCUMENTATION PROVING THEY DID PAY? I DON’T WANT TO TAKE THEIR WORD FOR IT….

medicare fraud