Emergency Room Bills Targeted in Hospital Fraud Study

Suspicions that five private hospital groups in Britain are operating a money-making cartel which includes raising emergency room bills have led to an investigation by the Competition Commission, according to The Telegraph.

Emergency Room Bills Targeted in Hospital Fraud Study

The news source reported that the inquiry came after previous studies alleged that hospital groups made inflexible pricing arrangements with insurers, as the aim of this was to exclude certain organizations from competing in the market.

Dr. Natalie-Jane Macdonald, managing director of Bupa Health and Wellbeing, noted that hospitals in Britain were half-empty. This implicated both insurance companies and medical staff, as they were alleged to have done unwarranted tests and treatments on the patients who were there to stay in business and generate more revenue, according to the news source.

Along with these allegedly unnecessary treatments, which may have led to higher costs for patients, the health insurance premiums have risen by 10 percent annually in the UK, and at a higher rate for expats who are buying international coverage. This rise, coupled with the alleged practice of generating more money through extra medical tests, has many wary about the state of the industry in England.

According to the London-based Association of International Medical Insurance Providers (AIMIP), fraud is endemic in parts of the system.

"We are working among ourselves and with other industry bodies and databases to share information and combat provider fraud and inflated costs—for instance where hospitals are overcharging, charging for treatments they never did, or are overtreating, such as unnecessarily long admission periods," Carl Carter, chairman of AIMIP, told the news source.

Carter highlighted a specific case in which a man with a nosebleed was almost forced to stay in a hospital for more than 30 days, because he was told that his condition was extremely serious. After he contacted his insurance company, according to the news source, the man was able to lower the time that he would spend in the medical facility to a three-day observation period.

This is not a trend that is specific to the UK, as a New York City man recently received a $44.8 million bill from a hospital after his treatment, a mistake that was identified by a billing company, according to The Associated Press.

Emergency Room Bills Targeted in Hospital Fraud Study

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