Medical Overbilling is Taking Money from Your Health Plan and Participants

[Omaha Steve]

https://www.laborpress.org/medical-overbilling-is-taking-money-from-your-health-plan-and-participants/

February 15, 2024
Charles Greenawalt, BA & Kevin Renner, MBA
LaborPress

If one of your health plan participants recently underwent surgery, visited an emergency room, or stayed in the hospital, chances are good your plan and member have been overcharged for the care. Chances are good as well that no one noticed or knew how to spot the unfair billing.

Every day unions and employers use our company to review medical bills for accuracy and fairness. We often find billing errors, greed, and fraud. For example, a podiatrist in New York elected to use an assistant surgeon for two common surgeries on a patient. That assistant surgeon alone billed $169,410. Fair payment for the assistant as determined by our surgeon review was $632.

In another case we reviewed, a police officer suffered a severe open fracture of his heel bone in the line of duty. The hospital bill for 20 days came to $761,464. After WellRithms’ review and repricing, the hospital accepted payment of $187,782.

Billing errors and abuse often go unnoticed but can quickly add up. Research published in the JAMA Open Network in 2019 found medical pricing irregularities, fraud, and abuse could cost between $289 billion and $324 billion annually. This is more than New York’s entire 2024 state budget of $229 billion.

FULL story at link above.