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When so-called providers should NOT be paid

Posted: Sat Jul 09, 2016 1:05 pm
by ConcernedCit
Does anyone in this forum have any experience with "single-payer-healthcare" insurers paying purported, "providers," when they should NOT pay them? For example, when the patient lets the insurer know - with proof, if indicated - that the so-called, "provider" did NOT provide healthcare? Specifically, that instead, it committed malpractice?

I would be interested in hearing about your own case, if it fits this pattern.

Re: When so-called providers should NOT be paid

Posted: Sat Jul 09, 2016 5:23 pm
by editor
I would consider what you describe as being fraud, rather than malpractice. I imagine it happens all the time, and that very few health providers are prosecuted, although I have read of a few cases over the years.

More often, health providers will tack on relatively small items to an otherwise legitimate account. For example, in my book I describe the cart that nurses always wheel into the room of a new mother. The cart usually has a bed on top where baby can sleep, and underneath are compartments with diapers, talc, lotion, wipes, blankets, etc. If mother uses even one diaper out of the cart, she gets billed for the whole cart -- usually in the neighborhood of $500, if I remember correctly.

If you tell the nurse to "just wheel that cart right back out of here, we won't be using it," the nurse is trained to say, "I'll leave it here just in case, but you don't have to use it if you don't want to." Then, it appears on the bill anyway. If your insurance provider is paying, then you probably don't even notice. If you're paying, and call it to their attention, they'll claim "mistake", and take it off the bill. It's really fraud, but difficult to prove.