Posted on 02/23/2018 5:20:13 AM PST by Wolfie
Two More Blatant Health Scams: Where Are Indictments?
How blatant do you need to be in stealing billions before someone goes to prison?
Let's start with this one:
A Texas woman took a urine drug test after back surgery and was hit with a $17,850 lab bill, according to a Kaiser Health News report.
This was for a set of tests that her health insurer says are worth $100.92 -- but since she was out-of-network she was billed 176 times as much.
Did someone do 176 times as much work? Did they do any additional work? Was she told about this before the tests were run?
All answers are no.
How is this not felony grand theft and fraud? Indeed this sort of crap is an everyday occurrence.
Next up, and at least as bad, is this:
Long considered one of the healthcare industry’s dirty secrets, the Medicare 340B program is under new scrutiny after a major study revealed that “hospitals that save money through 340B program discounts often don’t use those savings to improve care for low-income and underserved patients.” They are padding hospital profits while driving up healthcare costs.
Rather than using those discounts to provide care for low-income people they are instead diverting the drugs bought under that price to full-price patients and in fact absorbed physician private practices to facilitate this.
In other words, hospitals become eligible for 340B from their low-income patients, then expand to satellite facilities in nearby, affluent neighborhoods to make a huge profit on half-off drugs their rich patients’ pay for in full.
How does this not qualify as Racketeering?
These people stole drugs that were provided to them specifically for low-income people, diverting them to higher-paying people. When that wasn't enough they started buying up private practices to increase the number of patients against whom they could execute the scheme!
C'mon folks, cut the crap. This isn't "enterprise" or "innovation."
It's theft, fraud, and since it's undertaken with lots of people all conniving to do it it damn well ought to be considered to fit the profile for Racketeering and result in the forfeiture of all of these hospitals, all of these doctor practices and the imprisonment of everyone involved.
I doubt the accuracy of the bill. Probably included surgery or other cost and wrongly listed as lab work.
“It’s theft, fraud, and since it’s undertaken with lots of people all conniving to do it it damn well ought to be considered to fit the profile for Racketeering and result in the forfeiture of all of these hospitals, all of these doctor practices and the imprisonment of everyone involved.”
I agree with almost everything you said, but I highly doubt the physicians involved had anything to do with it - unless you are talking about physicians who are administrators. Most physicians order tests they think are necessary, and don’t have anything to do with pricing of any tests - unless they are ‘lab medicine’ doctors, who run the lab facilities.
The reality is that none of this is ‘real’ based on true costs. It’s all just a matter cost shifting to hit their desired bottom line.
I’d also like to point out something very important with regards health care costs and why they are ridiculous. Administrative costs are a huge component. There has been explosive growth in the number of health care administrators over the past two decades, and now the ratio of physicians to other health care workers is 1:16. Of those sixteen, only six are involved in patient care (nurses, technicians, etc.). The other ten are administrators.
The administrative costs in most other Western nations is between 8-15% of total health care costs. In the US it is 27-28%. That’s a huge contributor to costs. There are a significant number of 7 and even 8 figure administrators in most large hospitals, and a lot more six figure administrators. Those costs add up quickly, and they pay for them by pushing docs to see more patients in shorter time periods, getting patients out of the hospital as early as possible and turning over those beds, and adding costs where they can and still get reimbursed by the insurers.
Very little of this expansion of administrators has had a positive effect on health care, and most of it has had a very palpable and serious negative effect.
It’s a complicated topic, but very, very important.
Probably included surgery or other cost and wrongly listed as lab work.
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I don’t think so ,, this is from a Kaiser report... my “annual physical” lab work was billed at over $2k ,, don’t know what the insurer actually paid ,, maybe $250...
Nope.
https://www.beckershospitalreview.com/finance/physician-s-daughter-hit-with-a-17k-surprise-bill-urine-test-7-things-to-know.html
Here are seven things to know about the issue.
1. Elizabeth Moreno, a 30-year-old expectant mother finishing coursework at Texas State University in San Marcos, had back surgery three years ago. Per her surgeon's recommendations, she took an opioid painkiller after the operation, and then followed up with a urine drug test, according to the report.
2. A 2017 bill from Houston-based Sunset Labs and obtained by KHN shows Ms. Moreno was charged a total of $17,850. This amount included $2,975 to test for benzodiazepines, $1,700 to test for amphetamines, $850 to test for methadone and $425 to test for cocaine, among various other charges.
3. Ms. Moreno's insurer, Blue Cross and Blue Shield of Texas, said it would not cover the charges since the lab was out-of-network. If the lab was in-network, the insurer said it would have valued the work at just $100.92, according to the report.
4. Ms. Moreno's father, Paul Davis, MD, a retired physician from Ohio, fought the charges. He said in the report Sunset Labs ignored him when he requested a complete explanation of charges. Dr. Davis also accused the lab of "price gouging of staggering proportions" in a complaint filed with the Texas attorney general's office last May, according to the KHN report.
5. A spokesperson for Texas Attorney General Ken Paxton told the publication: "We have received complaints about that business, but we can't comment on anything else."
6. Lab attorney Justo Mendez told KHN in a statement: Sunset's charges "are in line with the charges of competing out-of-network labs in the geographical area."
7. Dr. Davis said he ultimately settled the bill for $5,000 in April, according to the report.
If you have no insurance, or if your hospital bills are being paid by workman's comp or automobile insurance, the full rate applies.
It is a fraud and a scam, and it is part of the reason why healthcare costs are so high in the U.S.
And...it’s illegal under U.S law. But nobody has the stones to prosecute.
1. The patient should have paid the fair market value of the lab services performed (something her father could find out and document), for those services her physicians actually ordered — with “payment in full” written on the check. Let the lab sue if it desires to defend its charges on the public record (if the check arrived with a tightly argued letter from her attorney, they might just be glad they got something and fold). Countersue for fraud. Use discovery to determine the lab’s own “fair market valuation” of the services.
2. Why was the labwork sent to an out-of-network lab? Who made that decision? This situation has “kickback scheme” written all over it. That’s what the State AG should look into.
The only real recourse most people who are not rich have is to go to the state's attorney, who (as in this case) have basically granted letters of marque to any 'health care' business to pirate your wallet.
But nobody has the stones to prosecute.
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No one can prosecute because Congress refuses to confirm the Deputy Attorney Generals for any of the DOJ divisions as part of their disloyal pranks.
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