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September 21, 2012 at 10:18 AM
Reporters at the Center for Public Integrity — an investigative journalism organization — have published a package of articles on doctors’ and hospitals’ use of aggressive medical billing practices — and electronic health record (EHR) systems — to inflate Medicare bills.
The reporters have pointed out that hospitals have used the convoluted U.S. medical billing system to “grab at least $1 billion in extra fees for emergency room visits” from Medicare, and they noted in one article that providers seem to be using EHR systems to automate the process of looking for opportunities to bill patients, and payers, for more expensive services.
“Regulators may lack the auditing tools to verify the legitimacy of millions of medical bills spit out by computerized records programs, which can create exquisitely detailed patient files with just a few mouse clicks,” the reporters write.
Medicare and Medicaid fraud investigators seem to put out more press releases than private plan investigators do, but, clearly, this is a problem for private plans as well as government plans.
Ddoctors and hospitals clearly try to overbill patients with private coverage as well as patients in Medicare. About a year ago, my own doctors found ways to turn my own “free” checkup into a $400 sick visit, and, in the process, gave me a file that made me look as if I were probably ineligible for life insurance, disability insurance or long-term care insurance because I was already dead.
Concerns about provider upcoding will come as no surprise to anyone who can remember reading any newspapers back in the 1970s.
Doctors today may have justifiable complaints about health insurers devouring their time with efforts to micro manage bills and demanding absurd provider discounts.
