Patients are often shocked when they get a bill in the mail after a routine visit. A major surgery can cost hundreds of thousands of dollars. Looking closer at the bill, you may see questionable charges or things that appear to be double charges for the same thing, charges for the wrong item, or overlapping charges. These billing errors may be more than clerical mistakes. The way some doctors charge for care may actually be putting patients at risk of injury.
Upcoding and Unnecessary Procedures
Common examples of Medicare fraud include billing for services that were never provided, paying kickbacks for referrals, unbundling, and upcoding. Upcoding is the practice of billing for a more expensive service than the service provided. An example may be charging a follow-up doctor’s visit as a new inpatient consultation.
Unbundling involves bundling services together then billing for the bundled services separately. In 1998, GlaxoSmithKline settled a lawsuit with the Department of Justice after a whistleblower came forward to report the company’s practice of offering “cheaper” bundled blood tests and then unbundling the package to bill the federal government separately for each test.
Upcoding is a common type of healthcare fraud. Healthcare fraud does more than just cost taxpayers and healthcare patients money. Fraud can also put patients at risk of injury or harm. One of the ways healthcare fraud can injure patients is through unnecessary procedures, treatments, and medications.
Doctors may perform unnecessary and potentially dangerous procedures, just to bill more money to the insurance companies. Unfortunately, even the hospitals and medical centers who may suspect unnecessary treatment fail to do anything because it helps their bottom line.
Unnecessary Procedures and Malpractice
We have highlighted dozens of cases where unnecessary medical procedures injured patients and caused serious harm just for the sake of billing. In August 2020, we discussed a doctor who fled the country after fraud charges. Abubakar Atiq Durrani performed hundreds of unnecessary spinal surgeries to bill insurance companies and Medicare. Almost 500 civil lawsuits were filed against the former doctor. Like many of these cases, patients and even other doctors raised concerns but the state medical board and hospitals failed to take action until lawsuits were filed.
Unnecessary procedures are also common in dental practices. An investigation found many patients who had a diagnosis of multiple cavities went for a second opinion and another dentist found no cavities. The injuries to patients include removal of healthy teeth, improper dental care, infections, tooth pain, nerve damage, and unnecessary anesthesia.
Whistleblowers Reporting Upcoding Fraud
An employee at a Nevada hospital witnessed some questionable coding and billing practices and brought them forward to supervisors. Instead of thanking the employee for finding possibly dangerous practices, the hospital fired the employee for questioning upcoded Medicare bills.
Paula Sellers ran the Boulder City Hospital’s health information department and questioned her bosses about the coding. According to a lawsuit, her bosses told her to back off and when she refused to sign off on the questionable bills, she was fired. Sellers filed a wrongful termination lawsuit for blowing the whistle on healthcare fraud that injures patients and their families.
After Unnecessary Treatment
Hospitals like to pretend like they are innocent after a doctor is caught making a mistake that hurts patients. Unfortunately, the hospitals are often on notice of bad practices and may even turn away as long as it makes them more money. If you or a family member suffered an injury because of an unnecessary procedure, contact the medical malpractice lawyers at Gilman & Bedigian online to get started on your case.
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