The following is an excerpt from a story in ProPublica and The Texas Tribune.
A Doctor Went to His Own Employer for a COVID-19 Antibody Test. It Cost $10,984.
Physicians Premier ER charged Dr. Zachary Sussman’s insurance $10,984 for his COVID-19 antibody test even though Sussman worked for the chain and knows the testing materials only cost about $8. Even more surprising: The insurer paid in full.
When Dr. Zachary Sussman went to Physicians Premier ER in Austin for a COVID-19 antibody test, he assumed he would get a freebie because he was a doctor for the chain. Instead, the free-standing emergency room charged his insurance company an astonishing $10,984 for the visit — and got paid every penny, with no pushback.
The bill left him so dismayed he quit his job. And now, after ProPublica’s questions, the parent company of his insurer said the case is being investigated and could lead to repayment or a referral to law enforcement.
When Dr. Zachary Sussman went to Physicians Premier ER in Austin for a COVID-19 antibody test, he assumed he would get a freebie because he was a doctor for the chain. Instead, the free-standing emergency room charged his insurance company an astonishing $10,984 for the visit — and got paid every penny, with no pushback.
The bill left him so dismayed he quit his job. And now, after ProPublica’s questions, the parent company of his insurer said the case is being investigated and could lead to repayment or a referral to law enforcement.
The case is the latest to show how providers have sometimes charged exorbitant prices for visits for simple and inexpensive COVID-19 tests. ProPublica recently reported how a $175 COVID-19 test resulted in charges of $2,479 at a different free-standing ER in Texas. In that situation, the health plan said the payment for the visit would be reduced and the facility said the family would not receive a bill. In Sussman’s case, the insurer paid it all. But those dollars come from people who pay insurance premiums, and health experts say high prices are a major reason why Americans pay so much for health care. (Continued)
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It is clear that medical insurance is insurance fraud. If I go to the ER, they are going to charge me hundreds or thousands of dollars for items that are purchased for a few bucks. Aspirin and suture kits are two items that come to mind. They overcharge my insurance and then turn around and provide basically free medical care to people who either cannot or will not pay for the services.
So hospitals KNOWINGLY overcharge insurance carrier A to cover costs for people who are not insured.
That's the definition of fraud.
IF AMERICANS HAD TO BUY FOOD the way we are insured for medical there would be a REAL REVOLUTION.
Oh, stupid me, there’s still a chance this could happen.
Quiet please, you might disturb the thieves..
That wouldn’t be the end of the story. Likely that the insurance company will only pay a small amount and the hospital will submit the unpaid balance to the government as a “loss”. The taxpayer repays the hospital for the fraudulent “loss” . A Keith Smith discusses this with Russ Roberts on EconTalk EconTalk.org episode on 18 Nov 2019.
double paras..... oh, editor....
Sadly, in this day and age, catching these criminals isn't enough to stop them. We'll need multiple lawsuits and years of time...and some Leftist activist judge will just decree that the People must continue footing the bill for $11K tests.
Pierce the corporate veil for fraud and negligence and sue the exact individuals responsible in the business structure.
Looking at publicly traded companies, Physicians Premier was not listed, so it is apparently a private company.
This needs to be investigated. The company, while providing services, may be a scam.
The government needs to audit the company, and the physicians, if he brings this forward, might be awarded an enormous amount of money.
Several years ago, a company was illegally overbilling medicare claims or claims of some sort, involving dialysis, and it resulted in a payout of many millions of dollars to the doctor involved who blew the whistle on the scam.
They charged me 6,700 dollar for a visit for covid here in Florida of which they said I did meet the criteria to warrant a test ... They sent me home for two week quarantine because I came to the hospital and could have caught it when i came to the hospital . WHEN i saw the bill i hit the floor. THEY RIPPING OFF THE INSURANCE COMPANIES AND THE PEOPLE.