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Politics : A US National Health Care System? -- Ignore unavailable to you. Want to Upgrade?

To: J_F_Shepard who wrote (34887)	3/5/2014 3:35:38 PM
From: i-node	1 Recommendation Recommended By Brumar89 Read Replies (1) \| Respond to of 42652

> .simple greed and fraud.... If you're dealing with a reputable provider it is more likely a simple mistake. >> I posted here a few months ago about an orthopedist from my group who had billings of over 7 million dollars over two years.... He billed for fake surgeries, phantom surgeries......as many as 19 surgeries a day... He claimed office visits from about 50 patients a day..... He was caught but it wasn't by his own billing department.... You didn't say whether this was Medicare, Medicaid or private insurance fraud -- but I would wager it was Medicare. Because it is just so easy. If a procedure is coded correctly, no one questions it. If you have a surgeon report doing a total knee, no one looks to see whether the hospital billed, whether proper referrals were made, nothing. There is a good CPT and a good Diagnosis, the provider is enrolled, write the check. Only an idiot would attempt this against against a private insurance company when Medicare is a sitting duck. Even Medicaid is a riskier fraud target.

To: J_F_Shepard who wrote (34887)	3/5/2014 3:58:27 PM
From: Lane3	Read Replies (1) \| Respond to of 42652

You should know what services you received and the patient shouldn't have to know the codes to see what he was billed for .... That is not always easy and, with the kind of setup we have, there's little motivation to make the effort. Even if you make the effort, satisfaction is unlikely. You'd have to be obsessive to count the pain meds you were administered in a hospital. As for judging much of what you receive, you'd have to have a medical background. When you are feeling lousy, you aren't paying directly for anything, and the payer does not care, the incentive just isn't there. Did you complain to the provider's office?? I did not challenge the dermatologist. Didn't see the point after the payer showed no interest. I just reported my experience to the person who had recommended him, switched dermatologists, and registered the event as a lesson learned. Hopefully he lost two patients, not just one.

To: J_F_Shepard who wrote (34887)	3/5/2014 3:58:33 PM
From: Lane3	Respond to of 42652

You should know what services you received and the patient shouldn't have to know the codes to see what he was billed for .... That is not always easy and, with the kind of setup we have, there's little motivation to make the effort. Even if you make the effort, satisfaction is unlikely. You'd have to be obsessive to count the pain meds you were administered in a hospital. As for judging much of what you receive, you'd have to have a medical background. When you are feeling lousy, you aren't paying directly for anything, and the payer does not care, the incentive just isn't there. Did you complain to the provider's office?? I did not challenge the dermatologist. Didn't see the point after the payer showed no interest. I just reported my experience to the person who had recommended him, switched dermatologists, and registered the event as a lesson learned. Hopefully he lost two patients, not just one.