Malpractice, Fraud, Outrageousness!!

[Peds]

How do ppl practice like this?
How did this just get glanced over by billing?
When will adults learn?

https://www.npr.org/sections/health-...ghed-up-25-865

[Hatton]

Crazy. I have refused to pay some lab bills on myself that I thought were crazy. Maybe $2500 but nothing like this. Labs and hospitals charge ridiculous prices. They will say they provide "free" care and the insured need to pay up. Medicine should not be about maximizing the profit for hospitals and labs.

[Lordosis]

This is awful. They should string this physician up in public.

[Lithium]

Clearly this means we haven't hired enough administrators!

[Tangler]

exactly! They are well known for lowering healthcare costs and they add so much value.

[Cubicle]

Man... I'm in the wrong business. And I'm an idiot for getting onto insurance panels. I don't need to invest in the markets. I need to up my billing game.

[wideopenspaces]

Is this seriously legal?

Also I remember seeing something similar where the patients were being sent checks instead of the doctors office and the patients were not using the money to pay the medical bills and there was nothing the doctors offices could do. I'm pretty sure she could have pocketed the check, which is why the office picked it up by courier. But in this case that would be one way to give the doctor a taste of his own medicine.

[AR]

Is this seriously legal?

Also I remember seeing something similar where the patients were being sent checks instead of the doctors office and the patients were not using the money to pay the medical bills and there was nothing the doctors offices could do. I'm pretty sure she could have pocketed the check, which is why the office picked it up by courier. But in this case that would be one way to give the doctor a taste of his own medicine.

Well, the part about there being nothing the doctor can do is incorrect.

The doctor can go after you aggressively to collect the debt. Now if patient is poor and unemployed and spends the money immediately, then there is not much the doctor can do. They can sue the patient for the money, but they can't get money the patient doesn't have or never will.

But for someone with assets, they would be highly incentivized to go after the patient for the money by any means necessary. This case is odd obviously, but in the case of a legitimate charge, I think the patient would end up paying one way or another. And this woman probably had 25K they could have come after.

I think she is to be commended for actually taking the time to right this wrong for no personal gain. She could have just passed the check on and saved whatever hours she spent doing something more pleasant.

[wideopenspaces]

Well, the part about there being nothing the doctor can do is incorrect.

The doctor can go after you aggressively to collect the debt. Now if patient is poor and unemployed and spends the money immediately, then there is not much the doctor can do. They can sue the patient for the money, but they can't get money the patient doesn't have or never will.

But for someone with assets, they would be highly incentivized to go after the patient for the money by any means necessary. This case is odd obviously, but in the case of a legitimate charge, I think the patient would end up paying one way or another. And this woman probably had 25K they could have come after.

I think she is to be commended for actually taking the time to right this wrong for no personal gain. She could have just passed the check on and saved whatever hours she spent doing something more pleasant.

This is the article I was remembering. . .

https://www.google.com/amp/s/amp.cnn...ise/index.html

[southerndoc]

I'm surprised this hasn't made its way to Bogleheads yet. Lots of physician bashing there, and this is a prime opportunity for them.

Insurance companies purposefully mail out-of-network checks to patients instead of physicians. They do this to discourage physicians from going against the almighty insurer and not contracting with them. First they low-ball rates, then they pay the patient instead of the doctor.

[AR]

This is the article I was remembering. . .

https://www.google.com/amp/s/amp.cnn...ise/index.html

Yeah, that article more or less says what I was saying. Excerpts from the article:

"Health care providers, medical professionals and attorneys familiar with this insurance practice told CNN that patients who receive money from insurers typically cannot be held criminally responsible if they never turn the cash over to their provider. But the patients can be held financially responsible."

"Sam Fenderson, a surgical assistant in the Atlanta area, said Anthem's tactics have very real consequences for providers like him.
He said that about $147,000 owed for his services over the past three years was sent to patients, and it's been draining trying to recover the funds. "That was really frustrating, because the payment was there," he said. "It was just a matter of the patient sending the payment on to me."
He said he's had to go to the extraordinary measure of suing 17 patients to try to get the money. He said four people declared bankruptcy,meaning he couldn't try to recoup that money. Some of the other cases are still in small-claims court.
While most counties view the issue as a civil matter, Fenderson said, he's found one county in Georgia that considers it a crime when patients keep the cash. Newton County considers it "theft by conversion" felony for amounts over $1,000; prosecutors said they've charged two people in the county."

[southerndoc]

I would think it generally is theft by conversion. Why would it not be? If someone accidentally is deposited money into their bank account, spends it, and is unable to repay it, then that is considered theft by conversion and people are charged (a couple recently made headlines after receiving a large amount of money and doing just that). Yet when an insurer pays a provider through the patient, then all of a sudden it's not theft by conversion? That's ridiculous.

[ENT Doc]

Perhaps the insurer hadn’t quite met its 80% mandated loss ratio.

[Zaphod]

How do ppl practice like this?
How did this just get glanced over by billing?
When will adults learn?

https://www.npr.org/sections/health-...ghed-up-25-865

They are billing. Its insane to me, there really cant be a way it isnt a Stark violation or outright fraud right? You can suggest a lab, imaging, etc...but you have to disclose (i think) and mention they could use others. Unfortunately, while I at times think stark stuff can be dumb, even if started in earnest, these kind of incentives can result in really bad behavior. Even if its just tiny and voluminous, it still matters, and we're all responsive to incentives as much as we wish we were better people.

At least thats what I thought, maybe I have misinterpreted the rules

[AR]

They are billing. Its insane to me, there really cant be a way it isnt a Stark violation or outright fraud right? You can suggest a lab, imaging, etc...but you have to disclose (i think) and mention they could use others. Unfortunately, while I at times think stark stuff can be dumb, even if started in earnest, these kind of incentives can result in really bad behavior. Even if its just tiny and voluminous, it still matters, and we're all responsive to incentives as much as we wish we were better people.

At least thats what I thought, maybe I have misinterpreted the rules

I'm not an expert on this, so I could be wrong, but as far as Stark is concerned, I think you can sent it to your own lab. The only issue is that you can't divide up profits among owners based on how much you send to the lab.

What you can't do is send to a lab that you don't own, but have a financial relationship with. That's not allowed. According to the article it seems like they had the ownership structure set up so that it was all owned by one entity.

[Lordosis]

Technically legal or not it is obviously abuse and this gives all of us a bad rap.