Hospital Billing Fraud

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

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

True Scenario:
Go to Physician
He is employed by the hospital you work for.
Your insurance is through that hospital, your employer.
The physician has signed a contract with and is a preferred provider for your insurance- as your PCP.
You have a health condition that requires you to receive the pneumonia vaccination every 5 years.

You go to Dr.s office and they tell you the vaccine is not covered by your insurance. The cost will be $120.

You decide to go home and verify (5yrs ago it was covered same doc/same insurance)
The insurance company says it is covered.

You call the physicians office. You get the Tech. They say that “it is covered but they don’t pay me enough to do the shot. So we don’t use the insurance on that. You must pay the $120.”
Now another patient, with medicare, gets same shot- his insurance is filed. He pays nothing.

They (office manager) say they have the right to do that on items that would not make a profit.

Um- I thought thats why we had insurance?

health care billing

Divorced since 2003, ex does not live with me nor is a dependant, NOT on cobra, and remarried in 2004 (lives with new wife). A georgia policeman told me “you can insure anyone you want”. 24 calls to other insurance agents all agree with me- it is not legal. Who is really right???

PS- if the health ins was provided under a domestic partners policy would that be fraud in ga??
I asked the police because I’m the new wife. It’s not Cobra, it’s Ex-wife and MY husband in this fraud together. I have her insurance card (renewed in 2006) showing her name and his. OUR marriage in 04, he lives w/me, but has mail to her house.
Police blow me off as a revengeful liar trying to get the law to violate HIS privacy laws.
If nothing else, her employer is getting screwed to cover someone not elegible. Proof of the fraud will strengthen my divorce case, I think.
*The truth will set you free*

I just do not believe any insurance company would do this, willingly, it has to be fraud.

hospital billing office

We were paying for health insurance (blue cross & blue shield CareFirst PPO) through my husband’s job every two weeks for over a year until he quit on August 26th. But every time he or my son went to the doctor, they were coming back as ineligible. Upon calling the insurance company, I found out that no one on our policy had been eligible since March of 2008! This is also the time that his company went through an HR problem where they had no HR dept. at all for quite a few months. The lady at the insurance company said that someone from his job had gone in and adjusted our policy on September 3rd so that it shows no lapse in coverage. There should BE no policy; my husband quit on August 26th. The lady also said the policy is still active and covering our family. If someone went in and adjusted the policy, why didn’t they put the termination in?? We would like to get back the money paid into this since March, which is about $1200.00. The lady from the insurance company said that since the adjustment was made, all the denied claims will be paid. We would rather have the money and pay the bills off a little at a time, since the reason he quit is that we got evicted because the company cut everyone’s hours so badly and we have NO money. Is there a scenario where we can still get the money and was this legal of them in the first place?

physician billing