Without government regulation or guidelines from insurance companies, such as Medicare, hospitals are given free reign to determine standard practices when it comes to billing patients for rendered medical services. This leaves the opportunity for hospitals to take advantage of the vulnerability of the public by overcharging and up-selling patients with unnecessary treatments and controversial medical devices, all for the sake of a profit. Hospitals have reportedly dumped over $1 billion in inflated medical charges over the last decade onto taxpayers.
“It’s just about corporate greed. These corporations want the American public, the American worker, and the average man to feel as if they have to obtain the best technology,” says Ben Gordon, a lawyer at Levin, Papantonio, Thomas, Mitchell, Rafferty & Proctor, P.A.
“Coding” billing systems, such as the one that Medicare implements, have been an easy outlet for hospitals to inflate prices. Instead of evaluating the treatment details on a patient-to-patient basis and charging them accordingly, some hospitals have been using the two most expensive codes, a process known as “upcoding”, when billing Medicaid.
According to The Center for Public Integrity, from 2001 to 2008, use of Medicaid’s two most expensive billing codes nearly doubled from 25 to 45 percent of all billing claims in emergency room visits. In most cases, those that visited the emergency room were not admitted to the hospital and were treated for minor injuries or complications, yet were billed with costly services that weren’t even administered.
Medicare is aware of the problem, but yet it downplays the overcharging and does very little to verify the accuracy of what is actually being billed. Instead, it allows hospitals to set their own agenda on billing, while conducting very little auditing to filter out price gouging.
The inflated charges have also impacted health insurance premiums, increasing the out-of-pocket amount for patient percentage co-pays. Premiums consequently go up to reflect the rising cost of health services, which are being overcharged. And with rising premiums comes even more taxes for the taxpayers, especially under corporate healthcare, while the profit-driven healthcare industry does just that…profits.
This is a major problem in the country’s healthcare system, as citizens are taking hits to their wallets from both ends because the necessary billing regulations are not being enforced.
Krysta Loera is a writer and researcher with Ring of Fire. Follow her on Twitter @KrystaLoera