When those medical bill slips and errors add up, honestly, isn’t it just fraud?

pickpocket-300x200If department stores, car mechanics, or restaurants billed their customers in the same way that hospitals and doctors do, prosecutors might have their hands full. That’s because what patients now accept in sheepish fashion as simple “errors” or misstatements or curious charges on their medical bills more correctly ought to be called something else: fraud.

That’s the reluctant but tough view now taken by Elisabeth Rosenthal, an editor, journalist, and onetime practicing doctor.

She has written an Op-Ed for the New York Times, her former employer, in which she recounted how she long has reported on health care costs and economics, including in her much-praised book, “An American Sickness: How Healthcare Became Big Business and How You Can Take It Back.” She said she has listened to too many patient complaints, as well as experienced problems of her own, to keep allowing establishment medicine to deem its relentless chiseling, oops, a little mistake.

As she wrote:

“Much of what we accept as legal in medical billing would be regarded as fraud in any other sector. I have been circling around this conclusion for this past five years, as I’ve listened to patients’ stories while covering health care as a journalist and author. Now, after a summer of firsthand experience — my husband was in a bike crash in July — it’s time to call out this fact head-on. Many of the Democratic candidates are talking about practical fixes for our high-priced health care system, and some legislated or regulated solutions to the maddening world of medical billing would be welcome.”

Though she no doubt could offer a file full of abuses — and those get chronicled with infuriating regularity by her colleagues now at the Kaiser Health News Service — Rosenthal in her Op-Ed focuses on medical frauds she saw while watching the bills from her husband’s care after he got tossed from a bike in Washington, D.C.

She makes a point of praising the overall care he received, to be sure.

But she also found big concerns with expenses he incurred for what she calls: medical swag, cover charges, impostor billing, drive-by treatment, and forced upgrades. Because patients get ripped off by each and all these practices, they’re worth digging into.

She describes “medical swag” as all the products and devices that patients get stuck paying for, even though they may not need them or use them for little more than a blink. These include braces, crutches, commodes, and wheelchairs. She said her hubby got outfitted for a $319 neck brace for just a few minutes until techs could X-ray his neck and found it uninjured. Off came the brace, which also vanished. That didn’t stop the hospital for charging them for it — and for her insurer, without question, coughing up most of the cost. Customers at least get to keep regular swag — tchotchkes aimed at building a brand — Rosenthal wrote.

“Medical swag” is no small matter, as recent news articles have noted, reporting how federal prosecutors recently broke up a $1 billion scam involving Medicare, the elderly and unwanted and unneeded back, shoulder, and knee braces.

Rosenthal’s next justified beef focuses on fees that hospitals slap on, including a $7,143 “trauma activation” expense, what she described as a “cover charge” for emergency room care. Her rational question, though: Why is it called an ER if it doesn’t handle trauma cases, and why must there be a special expense to “activate” what are routine services in a highly specialized area that already is among the most costly in most hospitals?

She noted that ERs, after 9/11, persuaded the government that they should be allowed to charge extra to stay ready, 24/7, for crisis care. Which they did before. And would anyhow. But the cover charge keeps growing, as do other ER expenses, she reported. She said, for example, that her spouse went once into a CT scanner but still managed to generate three separate bills for examination of his head, upper spine, and face bones. Ding, ding, ding went the hospital cash register.

Her husband also required stiches, put in by a surgical resident. The family didn’t get charged for the services of a doctor in training, though. Instead, they were “impostor” billed, hit with the cost of the young surgeon’s most senior colleague. “Extender” charges — paying for experienced and expensive providers when patients really get junior colleagues — is far too common, Rosenthal reported. Hmm, imagine if the CEO of a retail chain watched a store clerk ring up a customer’s item and added in the whopping cost of her pay into the transaction? Really?

But, of course, for Rosenthal and her husband the indignities were not over. She also said they experienced “drive by” treatment, unnecessary and unwanted care that they still got gouged for. In this case, it involved an order for physical therapy. The therapist, however, rang them at their home just after her spouse got out of the ER. The therapist was clueless about his injury. But she looked, saw her patient was in too much pain to be helped by her, and left. Her company called twice more to try to visit. A therapist never did. They still racked up charges for three treatments.

She said the fifth category of expensive chicanery in her husband’s care involved “forced upgrades.” Her husband ran out of a prescription and needed to talk with his doctor about part of his care. But the trauma area where he might see his caregiver has limited hours, so they met instead in the ER. Big mistake. The talk, with the patient in street clothes and conversing without exam, was deemed ER care, with steep charges, accordingly. Rosenthal said her husband, at one point, also needed a finger splint adjusted, causing a doctor to pull out a pair of scissors to snip a bit of plastic off the end. He hit them with a bill for a surgery, atop the cost of an office visit, and a “facility fee.”

Does this sound all to frustrating and familiar?

In my practice, I see not only the harms that patients suffer while seeking medical services, but also their struggles to access and afford safe, efficient, and excellent medical care. This has become an ordeal due to the skyrocketing cost, complexity, and uncertainty of therapies and prescription medications, too many of which turn out to be dangerous drugs.

Many doctors and hospitals, no doubt, provide amazing care due to long, difficult hours of hard work by medical staff. But if practitioners and institutions want the respect and esteem they may deserve, they need to get real and to stop hiring battalions of paper-pushing billing bureaucrats and expensive-suited MBAs, all figuring how to wring every last penny out of sick and injured patients.

U.S. health care didn’t vault to the top of polls as the No. 1 concern of voters because Americans think it is excellent, accessible, and affordable. Quite the contrary. As the New York Times reported, “Health spending in the United States rose by 4.6% to $3.6 trillion in 2018 — accounting for 17.7% of the economy — compared to a growth rate of 4.2% in 2017.” Americans are paying more than ever for their health care, and their outcomes lag their counterparts in Western industrialized nations.

But doctors, hospitals, insurers, and politicians don’t seem to be getting the message that their most important constituency — us, their patients — not only are fed up with their excessive costs and duplicitous billing, we just plain old can’t afford them. Yes, it makes sense that we need to examine any bill with care. But when we’re sick or injured, must the medical bills pile up like snow drifts in a blizzard?

We also fear and loath medical billing “surprises,” expenses we get stuck with due to providers being “out of network” with our insurers — especially when we’re getting emergency care. We want the lawmakers and regulators in Washington, D.C., to deal with our concerns.

They have made it painful for this happen, if it finally does, particularly due to Republican obstinance.

We all need to remember our problems as we march toward the 2020 elections.

Patrick Malone & Associates, P.C. listed in Best Lawyers Rated by Super Lawyers Patrick A. Malone
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