Medical Billing Fraud & Improper Billing Practices

Improper billing practices happen more often in Colorado than you might imagine.

A few weeks ago, I posted an article about the many ways that hospitals are trying to take advantage of people who are hurt in car and motorcycle accidents. Because of some questions I received, I believe that the information bears repeating. Additionally, I’ll add some action steps below to help you advocate for yourself should you believe that you are the victim of medical billing fraud.

Now, let me start at the beginning…

Let’s say you’re in a motorcycle accident and you’re taken to the hospital. Very quickly in the process, the hospital will ask if your injuries are the result of an accident. Of course, you will say yes. (Or, your loved one will say yes on your behalf if you are unable.) But this brief question and answer session can lead to a terrible domino effect that may end up with you paying the hospital thousands and thousands of dollars more than you should because of medical billing fraud.

In a nutshell, when a hospital discovers that they are caring for the victim of a car or motorcycle accident, they are withholding all of their medical bills to find out if the victim receives a settlement from his or her personal injury case. Why? Hospitals stand to make more from victims’ legal settlements than they do from victims’ health insurance companies. Hospitals are held to agreed-upon amounts for services by the insurance companies. When billing victims directly, hospitals can bill much more for each service, pill and procedure that they provide.

So, even though it’s unethical and often illegal, hospitals will do everything they can to avoid billing an accident victim’s health insurance company, but this is exactly why people have health insurance in the first place!

These are improper billing practices and it must stop.

In fact, if you’ve been to a Health Management Organization (HMO) recently, you’ve probably noticed that they, too, are routinely asking whether the condition you’re facing is the result of an accident at work or otherwise. In doing this, they aren’t trying to gather more information to provide you with better treatment; they are trying to find out if they can get paid more from any settlement you might receive from a personal injury case.

This improper billing practice is ubiquitous and we all need to be more diligent about the way we answer questions at any healthcare provider.

What Are the Steps You Can Take to Prevent Medical Billing Fraud?

When you are admitted to the hospital after a car or motorcycle accident, take the following steps:

• Immediately provide the hospital with your health insurance information. Tell them explicitly and in writing that the hospital must bill your healthcare insurance provider. Then, ask for a copy of that signed document. If they try to withhold billing to take advantage of your future legal settlement, you can say that you told them in writing to bill your health insurance company.
• Do not give the hospital the other driver’s auto insurance information. They can’t use it to pay your bills (it’s not health insurance; it’s car insurance) and you’re just alerting them to the fact that you were in an accident.

Other improper billing practices that hospitals often employ to make more money off of your care is that they choose to provide treatments that aren’t part of your healthcare plan. Hospitals go outside your network when, very likely, your healthcare plan offers in-network coverage for your treatment. Then you end up paying full-price out of your own pocket.

Therefore, when you give a hospital your insurance information, you must explicitly state in writing that you only authorize them to use your healthcare insurance. Here is the language I recommend:

“I am providing my healthcare insurance to [name of hospital] and I only authorize treatment through my healthcare insurance provider’s in-network services. If [name of hospital] chooses to provide out-of-network services in my treatment, then [name of hospital] will be responsible for those costs.”

How to Report Medical Billing Fraud

Now, what do you do if you suspect that a hospital is using unethical billing practices in your treatment? I would advise that you handle this in one of two ways:

1. If you were in a car or motorcycle accident, ask a personal injury attorney to review your case and your medical bills. Colorado personal injury attorneys see these kinds of improper billing practices all the time. Not only will a good attorney be able to identify unethical billing practices, but they can fight for your legal rights. If a hospital is trying to put a lien on your future legal settlement, you’re going to need an attorney.
2. If you weren’t in an accident but you’re facing large, confusing medical bills for treatments you received, contact the hospital and insist that they give you an itemized medical bill. Also demand to know whether the service they provided was in-network or out-of-network for your healthcare insurance. If you don’t even recognize a doctor’s name on the bill, get clarification. You can also enter medical codes from hospital bills in Google and learn what the codes stand for. It’s not uncommon for people to discover that they’re being billed for treatments they never received from doctors they never met! If you suspect medical billing fraud, contact the Colorado District Attorney.

I find it astounding and infuriating that hospitals would try to make patients pay for medical treatments out of their own pockets when they have health insurance! This practice has become so commonplace that I suggest you share this article with friends and family. Help your loved ones to protect themselves and also, let them know how you’d like them to respond to hospital questions should you ever need them to act on your behalf.

If you have questions about this article, or if you’ve been in an accident and you’re concerned that a hospital is trying to access your legal settlement, call me today.

Related articles:

What Insurance Companies Don’t Want You to Know — You can’t trust even your own insurance company to do the right thing. Find out what your vehicle insurance company keeps secret.

Why Should You See a Doctor After an Accident — Taking care of yourself isn’t just smart, it can pay off, too.