Have Doctors and Hospitals Joined Banks as Fraudsters?

Citizen Wealth Financial Justice Health Care

New York City     It’s the holiday season when old time movies used to give us hope that miracles might happen.  Santa might climb down from the chimney, if you had a chimney anymore.  There were urban legends of teenagers finding car keys under the tree, although none of us  even remotely knew anyone who lived that miracle.  Some even thought there might suddenly be good will throughout the world.  Bah, humbug!

Maybe there’s something to all of that though?  Reports indicate that committees from both the US House and Senate are close to agreement to finally take some steps to stop “surprise billing” by doctors and hospitals.  Surprise billing occurs when a patient is using a hospital where their insurance is in full force, yet they get additional bills from doctors that are not covered, sometimes practitioners, anesthesiologists, or general blood suckers.  The step they seem to be contemplating seems small, but at least it’s forward.  They are debating a way to allow patients to appeal to reverse the charges.  It might make a difference.  Something to look forward to in 2021.

It’s not enough of course.  Elizabeth Rosenthal, a former Times reporter now working for Kaiser’s newsletter, raised the real question recently:  why are medical billing practices not fraud as they would be classified if practiced by other professions and industries?  A very good question!

If a building contractor charged you for putting in sheetrock in your back room or replacing the gutters on your roof, but then didn’t actually do it, it would be fraud.  Right?  We know that in wake of criminal charges, convictions, jail time, and lawsuits that fell like rain in the wake of Hurricane Katrina where unfortunately many homeowners were victimized by some rouge contractors.  Yet, doctors and hospitals routinely bill patients for procedures that they did not perform.  How is that not fraud?  Even worse they are ripping people off, just like the victims of Hurricane Katrina, at their most vulnerable when they are sick and desperate.  Added to that predatory behavior is price gouging, which is now simply standard operating procedure.

Yet this is regular behavior, just standard operating procedure.  Doctors who submit bills when they weren’t there; hospital charges for emergency room procedures when there was no other way to get care; doctors charging for nurse and intern work at their top rates, and more.  Accounting firms, legal practices, construction contractors, and others all charge apprentice rates for underlings rather than billing top-line prices. Why are doctors and hospitals allowed to engage in such exploitative and, frequently, fraudulent practices?

All of this is done with impunity.  The American Hospital Association just went to court recently to challenge the federal government over its rule that would force them to transparently publish their prices.  Tell me who does this?

Except on the wrong side of the law, that is.