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Predatory ER Overcharges and Hospital Overbilling Has to Stop

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Atlantis, FLWith hospitals, you really have to wonder if the inmates are running the penitentiary. Or at the very least, the business office. With no disrespect to the skilled doctors and nurses who are on the front lines in the emergency rooms of the nation, and against sometimes formidable odds calmly patching up our various hurts in the midst of constant panic (from the patient), whomever is responsible for ER overcharges for services may be a good candidate to get their own head examined.

Patients are hurting in the process, often having to pay exorbitant fees or co-payments that only add to the stress of a patient’s original injury. Little wonder that so many patients are turning into plaintiffs and filing lawsuits.

The moral and Hippocratic oaths of hospitals and medical practitioners hold that patients in need should never be denied critical care just because of an inability to pay. Admittedly, when hospitals treat poor Americans with little or no funds to pay the bill, they have to absorb the cost or overage of treating that patient.

However, according to various health care advocates, hospitals make up the shortfall by overcharging uninsured patrons with means or patients who carry insurance.

One can well imagine the challenges hospitals face to stay afloat. However, is this fair to the insured or affluent patient to inflate the cost of an emergency room procedure to almost 40 times the posted rate for that procedure?

Is it legal?

One lawsuit in Florida seeking class-action status asks those very questions, on both counts. In particular, two patients treated at JFK Medical Center in Atlantis, Florida, following separate automobile accidents allege procedures administered for their care in the emergency room were grossly inflated and the billed costs unlawful.

According to court records, one patient was charged $6,404 for a CT scan of the brain that would normally cost $163.96. The same patient was billed $5,900 for a CT scan of the spine, $3,359 for a lumbar spine X-ray and $2,222 for a thoracic spine X-ray. Those procedures, according to South Florida Medicare, carry standard “customary and reasonable” rates of $213.14, $51 and $38 respectively.

Fees for service can be inflated upwards of 40 times over standard rates

Beyond those charges appearing as unfair and even predatory, is the expectation that such charges are illegal. Under Florida law, all vehicle owners are required to carry personal injury protection (PIP) insurance. Insureds are required to pay a 20 percent deductible based on the billed costs of service rendered. But those costs are also required, under PIP statutes in the state of Florida, to fall within “customary and reasonable” pricing guidelines.

Both patients wound up having to pay for part of the bill out-of-pocket after the ER fees for service exhausted the limits of their PIP coverage.

According to various pundits, a gambit observed by most hospitals is to overbill those patients with health insurance, and then enter into negotiations with the insurance provider that usually results in the fees for service rolled back to a more reasonable amount. In fact, most insurers have been described as expecting an overage, and will subsequently push the hospital to lower the final bill for fees as a matter of course, not unlike going into a car dealer and negotiating a “deal” that falls below the sticker price.

Everybody knows that you don’t pay full price for a car. Negotiation is a given.

Same goes for health care.

But what of the Americans without insurance, either by choice or by circumstance, with either limited or unlimited means to pay? How much are they overbilled? And do they attempt to negotiate the fee, or just pay it?

Chances are, any uninsured patient billed for emergency room service has been overcharged - often substantially. Thus, any uninsured patient who may have made payments in full or in part has likely paid a far higher fee than standard rates for those procedures.

It’s time to fight back

Beyond the unfairness, it may be illegal. A telling example of the potential illegality is where a hospital will push to force full payment of a bill, only to back off and forgive all or part of the bill if a patient threatens to sue, ostensibly to avoid litigation. This gets the patient off the financial hook to the hospital - but it also lets the hospital off the hook as well, in terms of unfairness and alleged illegalities associated with overbilling.

According to attorney Barry Kramer, hospitals that are currently under investigation for overbilling uninsured patients include Dignity Health, Daughters of Charity Health System, Prime Healthcare, Scripps Health, Anmed Health, Moses Cone Health System, Harborview Medical Center, Lehigh Valley Health Network, Lexington Medical Center, Mayo Clinic, Mission Hospital, Palmetto Health, Sharp Medical Center and Memorial Health.

Regardless of a hospital’s attempt to roll back a complete or partial overcharge in response to a litigation threat, it behooves a potential plaintiff who has been grossly overcharged to take the hospital to task over chronic overbilling. Faced with the potential for costly settlements and compensation stemming from emergency room overcharge lawsuits, hospitals may very well re-think their policy with regard to needless and predatory overbilling.

Perhaps they may even stop altogether.

There is little doubt that running a hospital remains a formidable challenge, and underfunding is chronic. However, grossly overcharging innocent Americans is both unfair and potentially illegal. And like the bully in the candy store who will continue to sneak free sweets when the proprietor isn’t looking until he’s caught, hospitals are expected to continue the practice of overbilling as long as they can get away with it.

At least, until someone fights back.

So fight back…

The Florida lawsuit is Herrera et al. v. JFK Medical Center Ltd. et al., Case No. 14-CA-008372, in the 13th Judicial Circuit Court of the State of Florida.

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READER COMMENTS

Posted by

on
Physical Therapy way overcharged, OCT charged $1002 to watch me brush my teeth and wash my face. PT charged $1074. to walk me around hallway with a walker. IV came out of my hand and leaked on the bed, I slept on a wet cold bed for 2 days before bedding was changed. Phlebotomist cannot install a port properly, my hand was black and blue, drawing blood, left my arm black and blue. Had to try several times. Was not given towels or implements for shower. Had no shower for 5 days. Nurse on gvy abusive. push button for restroom, no one shows up, got chewed out for going to bathroom alone. The hospital was the worse experience I have ever had. Hospitals in Utah far superior to hospital in Carson City. PT was excellent, better interaction and training. I had none of this at Carson Tahoe.

Posted by

on
This article is right on the mark. The entire healthcare "insurance" industry is a racket that overcharges (extorts) those with the least negotiating power: the independent policy self employed like me or the uninsured, to subsidize the negotiated cheap cost of the "insured" or those "in the system. I have been paying exorbitant rates my entire career for essentially no coverage.
In March of 2013 I took my wife to Piedmont Hospital, Atlanta ER with extreme back pain from packing for a move.... after self diagnosing sciatica, or pinched nerve. We went to get prescribed muscle relaxant we could not get over the counter. We waited 3 hours while she threw up in the wastebasket we took with us, while every miscreant in Atl got free care. When we threatened to leave, they finally took her... misdiagnosed her with kidney stones, said she needed a CT scan. Gave meds for kidney stone and later billed us $8600 for the scan that would have charged medicare patient $192. Three days after ER, our own Piedmont doctor confirmed Sciatica. Based on his statement and the misdiagnosis and treatment, our attorney got the entire charge reduced to zero. But the system must be fixed. Obamacare is just half the problem. The looting of the little guy is totally unfair. Medical [profession should be forced to publish charges for each treatment online and every patient should pay some small portion of the cost. Those two changes would fix the system

Posted by

on
Predatory ER Providers= PERPs! An accurate abbreviation.

I read the NPR and New York Times stories about people being billed in the five figures by out of network providers after making sure to visit an ER in their network. My daughter was sent a $920 bill for 15 minutes of stitches by a PA, this after being assured by the hospital that everything would be billed in network.

I don't even know if Medical Emergency Professionals of MD belongs to any network at all or whether they send these exorbitant charges to everyone, knowing that few people will seek legal redress for amounts under $1000. Organizations such as these should be put out of business.

Posted by

on
When my son was born AnMed (one of the named hospitals) tried to over chargel us by several thousand dollars for procedures not performed and drugs not given. It took 6 months of fighting but I eventually won. (the care sucked as well) Screw AnMed, knowing what I know now, I wouldn't let them take care of my cat.

Posted by

on
You are so right, my wife was waiting for medicare to take effect. You have to wait 2 yrs when you go on social security disability. Dr. she was seeing said her white blood cells were high, since we had no medical insurance she suggested we go to the local county hospital ER. What a miserable place!

Anyway the final bill was $2400 dollars for them to tell her she had an respiratory infection and prescribe antibiotics. We could not pay this bill and the county took us to court and put a lean on our house, this extra financial burden at the time caused us to file bankruptcy.

Posted by

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The headache of having to pay exorbitant amounts of out-of-pocket money for injury can exacerbate the injury itself.

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