For more than a decade, taxpayer-funded health care programs have seen a steady uptick in higher-paying billing codes. Office visits, outpatient services, and emergency room care have all been billed at progressively higher reimbursement codes, raising fees by billions of dollars. Many providers contend the shift is the result of sicker patients coupled with the
North Carolina has long been a hot bed of expensive hospital bills. They regulate the billing through an agency for workers’ compensation and allow a percentage off charges. Those of you that know me, know I find percentage off charges meaningless. Recently, they adjusted the allowable percentage of charges from 95 percent down to 78
Implants are another hot topic for medical cost containment. They’re one of the biggest cost drivers in medical costs for workers’ compensation and auto. A group in California was just indicted for fraud with medical billing.The law in California allows for a $250 mark-up over the manufacturer’s invoice. This group was buying the implants, marking
The latest in medical billing fraud headlines reads: 107 people charged in healthcare fraud bust. It’s a bust that’s costing the government an estimated $450 million in false billings. In Miami, FL 59 people were charged; seven defendants were charged in Baton Rouge, LA; nine were charged in Houston, TX; eight in Los Angeles, CA; 22
It is very important that the US healthcare system become less conflictual and more “win/win” for the issues we have today to ever be resolved. I often hear how horrible the insurance companies are, and there may be many times when the stories are right. I can also say that spending a week or two reviewing
Read this story about a $5 million dollar “typo.” Most of us also remember the stock market crash caused when a broker typed 15 billion shares instead of 15 million, which was dubbed the fat-fingered market crash. I recently heard a story from an employee who caught a $500,000 bill that should have been $5,000 by calling
In many situations, a person who is injured receives treatment longer than expected. This is very common when people are taking prescriptions or pain medications for long periods of time. There can be many reasons: dependence, addiction, misdiagnosed causation, driving up claims costs for settlement, etc. One that is not often explored is the street value
