Health Care And Hospitals: Scam
The Market Ticker ® - Commentary on The Capital Markets
Posted 2012-01-11 07:46
by Karl Denninger
in Health Reform
Ignore this thread
Health Care And Hospitals: Scam
 

We must tear down the entire medical system in this nation and imprison virtually all of the financial folks involved in it -- especially Hospital-affiliated entities.

That's a strong statement.  But it's supported by reports like this in the NY Daily News, which illustrate nicely what I've talked about on The Ticker for a long time in relationship to health care, how it's broken, and what we must do to fix it.

The charges, in fact, were mind-boggling. A statement the hospital sent to my insurance company, Aetna, showed that Good Samaritan billed $22,214.92 for a four-hour emergency room visit that included a physical exam, sedation, endoscopy and extraction of the stuck food.

Even more astonishing, Aetna agreed to pay only $2,885.67 for the services — just 13% of the bill — and the hospital settled for that amount.

This sort of game-playing, where the intent is to catch "uninsured" people and "gotcha" them into bankruptcy, would be felonious in virtually any other line of business.

Services contracted without a price?  Billing someone for services where they are in no position to negotiate before service is provided at nearly ten times what you later accept -- from certain "favored" people -- while you chase everyone else for the "full" price?

Let's assume that you ran a gas station.  Your gas station posted no prices.  Further, the same gas was sold to different people, all of who were similarly situated at the time they pumped the gas, at different prices depending solely on who their employer was, and nobody would know the price of the gasoline until after they pumped it.  And if that wasn't enough insult the price would be $3/gallon for most people who worked for a long list of companies but if you were a passer-through in town and didn't work for any of those firms as a consequence the price would be $25/gallon.

This would run afoul of deceptive trade practices legislation virtually everywhere in any State.  You'd never get away with running a grocery store this way, or a cellphone company, or for that matter a hair salon.

It would be bad enough if the pricing was "just" 10x as high.  But in some cases it's even worse.

As but one example of what I discovered, consider Ondansetron HCl, an anti-nausea medication that both hospitals administered to my son. Good Samaritan charged $439.90 for the drug; Aetna allowed $77.63. Somerset charged $6.52; Aetna paid $3.26.

Medicare pays 17 cents per dose.

Oh really?  That's a factor of 2,582.  No, not 2,582% -- that would be outrageous!

It's actually charged at 258,200% of what Medicare pays.

And I'm willing to bet $1,000, right here and now, that the hospitals in question did not disclose (1) what the drug would be billed and cost before being administered and (2) what consequence, if any, would occur if you did not accept administration of that drug.

In this case the consequence could be that you vomit.

So to avoid puking you get overcharged by 258,000%.

THAT is enough to make you vomit all on its own.

The entire medical system in this country is a racket.  It is a scam designed to play on your fear of mortality or morbidity to rob you.  In any just society where the rule of law meant anything this sort of "billing system" and "practice" would lead to felony criminal charges and everyone involved would be sitting in a prison cell finding out all about the proper uses for anti-nausea medication to avoid throwing up as they were repeatedly instructed in the joys of gay prison sex.

If you want to know why our government is going broke and our financial system is headed for collapse within the next several years the reason is found right here.  This entire portion of our economy has become so imbued with graft, cost-shifting and scams that it is literally bankrupting everyone.

This is what the article claims Aetna said:

The driving force behind all this, according to Aetna, is the way hospitals and the government do business.

The rates that insurance companies pay are negotiated based on what they believe a hospital’s true costs are. But then those rates are jacked up an average of 30% to 50% to make up for money that hospitals lose in treating patients who don’t have private insurance — which is the majority of them. So to make up the difference, they overcharge patients who are insured. This practice is called cost-shifting.

This sort of collusive behavior by entities that have market power is illegal in virtually every line of business under the Sherman Act, among others.

So why haven't these firms all been prosecuted?

Oh you know the answer -- they went to Congress, "lobbied", and got special dispensation to be able to screw you blind in both eye sockets through business behavior that would land you or I in prison for 20+ years were we to try it -- including the collusion required to enforce this sort of ridiculous differential in billing -- in essentially any other line of business.

Tear it down. 

All of it.

Discussion below (registration required to post)
 

Main Navigation
Full-Text Search & Archives
Archive Access
Get Adobe Flash player





Blogtalk 3:30 CT Mondays
Items To Look At


Discuss The Capital Markets along with daily technical analysis with our Gold Donor program.

Where We Are, Where We're Heading (2013) - The annual 2013 Ticker

Links and Blogroll
Our policy on reciprocal links: Send us an email with your information and why you think your blog or news site would make a good addition - in most cases reciprocal link requests will be granted.
Seeking Alpha Certified
Legal Disclaimer

The content on this site is provided without any warranty, express or implied. All opinions expressed on this site are those of the author and may contain errors or omissions.

NO MATERIAL HERE CONSTITUTES "INVESTMENT ADVICE" NOR IS IT A RECOMMENDATION TO BUY OR SELL ANY FINANCIAL INSTRUMENT, INCLUDING BUT NOT LIMITED TO STOCKS, OPTIONS, BONDS OR FUTURES.

The author may have a position in any company or security mentioned herein. Actions you undertake as a consequence of any analysis, opinion or advertisement on this site are your sole responsibility.

Looking for "The Best of Market Ticker"? Check out
Ticker Classics.

Visit the forum to discuss this and other investing-related topics; see the FAQ on the forum for information about Gold Donor status including access to our technical analysis video server.

Market charts, when present, used with permission of TD Ameritrade/ThinkOrSwim Inc. Neither TD Ameritrade or ThinkOrSwim have reviewed, approved or disapproved any content herein.

Market Ticker content may be reproduced or excerpted online provided full attribution is given and the original article source is linked to. Please contact Karl Denninger for reprint permission in other media.

Submissions may be sent "over the transom" to The Editor at any time. To be considered for publication your submission must include full and correct contact information and be related to an economic or political matter of the day. All submissions become the property of The Market Ticker.

Leads on stories of current economic and political interest are always welcome. Our fax tip line is 850-897-9364; please include contact information with your transmission.

 
Comments.......
User: Not logged on
Login Register Top Blog Top Blog Topics FAQ
Showing Page 1 of 3  First123Last
User Info Health Care And Hospitals: Scam in forum [Market-Ticker]
Psquared
Posts: 1876
Incept: 2008-10-11

SE USA
Report This As A Bad Post Add To Your Ignored User List
Who are the big hospital operators in the US and are they private or public companies? I'd love to see how much profit they are making off of this kind of thing. I know, for example, in my city where we once had 4 hospitals all run independently including the local Catholic Hospital, all 4 now fly under the same corporate banner. There is no competition among these hospitals and they set their prices the same effectively cornering the market on medical care. The only hospital not part of this monopoly is about 20 miles from where I live and the ambulance would not take me there if I asked.

One of these candidates would surely get my vote if they would start talking about how to fix medical care. Even the doctors I know are fed up with it.

----------
"Our Constitution is designed only for a moral and religious people. It is wholly inadequate for any other." ~ John Adams
Cobra2411
Posts: 10335
Incept: 2007-06-26
Gold A True American Patriot!
Philly P.a.
Report This As A Bad Post Add To Your Ignored User List
I've seen the same thing. I carry insurance with a high initial co-pay so I pay out of pocket for most stuff. I do however get the negotiated price. So I pay $200/mo basically for price "protection" against overcharging. Recent bloodwork was billed initially at around $800 but negotiated to less than $80...

----------
To err is human. To really **** things up takes government.
Psquared
Posts: 1876
Incept: 2008-10-11

SE USA
Report This As A Bad Post Add To Your Ignored User List
Cobra, how does that work if you are paying out of pocket? Your insurance company is not even involved until you meet your deductible or copay is it?

I've been looking at one of these plans as an HSA or just the high deductible with no copay plan. The best price I've seen is about $350 a month. But then, I'm 58 years old.

----------
"Our Constitution is designed only for a moral and religious people. It is wholly inadequate for any other." ~ John Adams
Preidt2
Posts: 552
Incept: 2009-07-31
Green
spokane/wash
Report This As A Bad Post Add To Your Ignored User List

YES tear it down;I can get cheaper cost for services paying cash than using my 600 per month city insuance program total sh-t

----------
Puppets Under Destruction
Ress
Posts: 3
Incept: 2009-09-11

Report This As A Bad Post Add To Your Ignored User List
How about everyone just being on Medicare? Then we all pay 17 cents.
Bluebird
Posts: 1380
Incept: 2008-05-02
Silver
Report This As A Bad Post Add To Your Ignored User List
Spouse turns 65 in March for Medicare and takes no prescriptions. We are told we have to sign up for a Medicare drug plan. But why spend $30 a month for a plan for drugs that he doesn't use, or get a plan that we don't know if the drug will be covered if he needs a prescription. We are told if we don't sign up now that there will be a big penalty later.

What a scam.
Goforbroke
Posts: 5333
Incept: 2007-11-30
Gold A True American Patriot!
Just call me 'Comrade'
Report This As A Bad Post Add To Your Ignored User List
When we moved several years ago, the moving company had quoted us a certain amount. The guys showed up on moving day, claimed that the job would cost not what we had been quoted, but three times as much.

We were not in a position to negotiate, as this was a Friday and my daughter started school in the new district on Monday.

On our way to the new home, I called an attorney friend who educated us on the "quoted plus 10%" law here in Ohio. Apparently if you are quoted a certain amount, the provider of the product/service can not charge you more than 10% of the original quote.

After all of the stuff had been moved in, we gave them a check for the original quote plus 10%. First thing Monday morning, the attorney called their office. Net result is that the bill was indeed settled with the check we gave them.

If we didn't have the good fortune to be good friends with an attorney, we would have gotten royally screwed. I wonder just how many other victims this moving company has preyed upon in this manner.


----------
We have met the enemy and it is us. -- Pogo
Bigcowboy
Posts: 555
Incept: 2010-03-12
Gold
Michigan
Report This As A Bad Post Add To Your Ignored User List
Psquared: With my high deductible insurance, the doctor first bills the insurance company --- Blue Cross Blue Shield. If the doctor participates with BCBS, BCBS uses the negotiated price, computes the amount of money I have to pay and the amount of money BCBS will pay, and then tells the doctor what amount to bill me. If the doctor doesn't participate with BCBS, BCBS computes the amount of money I have to pay and the amount of money BCBS will pay, and then tells the doctor what amount to bill me.

-BigCowboy
Weezie
Posts: 6064
Incept: 2008-05-19
Gold A True American Patriot!
Caution: Congress at Work
Report This As A Bad Post Add To Your Ignored User List
Had this happen last year, Gen, to me.

Had an ER visit due to some major chest pains and labored breathing (fortunately, the cause was something far more benign). $16K+ ER bill (did not include ambulance, doctor and a few other things), insurance 'acceptable' was $4,300 (or close to that, don't have the exact figures in front of me).

I think the majority of the value of insurance (and I use the words 'value' and 'insurance' lightly) is simply to lock in the preferred charges instead of being reamed with the walk-in / uninsured ones.

----------
The election is not a way to have a voice in government, but rather an impotent declaration if we prefer ketchup or mustard on our **** sandwich.
Godot
Posts: 670
Incept: 2008-03-03
Green
Oz
Report This As A Bad Post Add To Your Ignored User List
Psquared, I am on a High Deductible Health Plan ($5,000 deductible, then 100% coverage after that).

The health care provider sends a claim to my insurance company's PPO administrator; the bill is marked down according to negotiated rates; insurance company sends me a benefit statement showing the charges and what I actually owe; then I pay the bill from my Health Savings Account. The insurance company keeps track of what I have paid and applies it to the deductible.

100% of the time, the provider has to write off a portion of the charges. When it comes to our local community hospital and its affiliated public-private labs and radiology services, the write-offs have been as high as 90%. It is not unusual for charges to be declined (and not payable by me at all) as either duplicates or unnecessary.

By the way, except for the university basketball and football coaches and athletic director, the hospital CEO is the highest paid public employee in our city, and probably close to highest paid in the state.

----------
Ilyachern
Posts: 796
Incept: 2007-06-26
Green
North Miami Beach Florida
Report This As A Bad Post Add To Your Ignored User List
The hospitals are required to accept and treat uninsured patients. That law is responsible for the cost shifting that occurs. It is the GOVERNMENT that forced this upon the public. Get rid of that law and the cost shifting together.

----------
The Fed won't be winding down their balance sheet. Their balance sheet will be winding down the Fed.
Level 9 9/23/09
Mortgageguymn
Posts: 1561
Incept: 2009-03-09
Green
North Coast
Report This As A Bad Post Add To Your Ignored User List
"How about everyone just being on Medicare. Then we all pay 17 cents."

Umm, no. Then we all pay whatever in taxes whatever the government spends through Medicare. Single payer may be better than what we have now, but there's no free lunch...other than for free loaders who don't pay any taxes.
Bsaxberg
Posts: 169
Incept: 2009-07-04

North Dakota
Report This As A Bad Post Add To Your Ignored User List
Weezie...same thing for me this last November. Less than 24 hours in the hospital (ER about an hour)....summary bill..$8000. Waiting on the detailed bill. Mine was chest pain but not a heart attack, couldn't breathe. Once they got me to oxygen and back to normal somewhat I was fine. They have no idea what it was sent me home on 6x the normal dose of antibiotics.
Tesla
Posts: 15541
Incept: 2008-04-03
Green A True American Patriot!
State of Disbelief
Report This As A Bad Post Add To Your Ignored User List
Quote:
100% of the time, the provider has to write off a portion of the charges.


Not always. The surgery recently performed on my kid was billed at $5347. Insurance paid $4840. She was billed the remainder of the $507 by the surgeon's office; her deductible had already been met by the $43k+ change hospital bill. smiley

----------
"Even a dog knows the difference between being stumbled over and being kicked." -Justice Oliver Wendell Holmes

"Neither the wisest Constitution nor the wisest laws will secure the liberty and happiness of a people whose manners are universally corrupt." -Samuel Adams
Firefly76
Posts: 49
Incept: 2011-08-09
Green
Houston TX
Report This As A Bad Post Add To Your Ignored User List
@ Psquared

Romney will fix it LMAO. Plus he made history yesterday!!!!

*ugp* sorry I just vomited in my mouth again. I think its the machine in this nation causing me to do that more and more often maybe some of those over priced drugs will help.

I think part of the reason Doc charge so much is because they get haggled down in the end by insurance and the gov covered.

Someone needs to find the REBOOT button but i fear the system will crash before that sucker is pushed.

Prep up people and I hope to see you on the other side.

smiley
Lucky1
Posts: 2019
Incept: 2009-08-05
Gold
Pittsburgh
Report This As A Bad Post Add To Your Ignored User List
Gen:

Yes; spending 7 1/2 years as Accounting Manager then Interim Controller and then as Director of Financial Services, both in Acute Care and in Long-Term Care, have been through Medicare cost report audits, etc.; tear it down is right.

To make it simple, the gross billing amounts are a standard charge. Anyone that has a contract (Commercial Insurance, Medicare and Medicaid (essentially a contract)with hospitals and hospital companies negotiate for certain percentage discounts, which the hospital books as Contractual Allowances (or "Contractuals") between Gross Revenue from amounts charged and Net Revenue (and thus Accounts Receivable). Medicare has a set of Standard Reimbursements for set Diagnosis Codes (with some variation for things like 'location' (urban versus rural hospitals - urban hospitals get larger payments for the same Codes due to higher costs for wages, etc.). Medicaid is negotiated with the State. There are also other minor 3rd parties like for Military, etc.

***If you are a patient and you walk in without a Contract (via being a participant with a contracted carrier, CI, MC or MA, etc.) then you are charged the Standard Charge.***

Much of that billing to those "Self-Pay" patients gets written off eventually, but not before the hospital either tortures the patient and family pursuing unpaid bills, or just sells off the Receivable to third party bill collectors for a huge discount, and the bill collector hounds the patient.


Your Ticker doesn't even go into the shady practice of 'Upcoding' where unscrupulous Providers bill for actual services, but code the bill for an illness that, while related, is much more severe than that with which the patient was actually afflicted, thus generating a higher payment. Not surprisingly, it is much easier to get away with when billing Medicare and Medicaid than Commercial Insurance, because Commercial Insurance companies have software that catch anomalies with software algorithms, Medicare for example, does not. A Provider submits a Bill, and it gets paid (unless there is an actual procedural mistake, it gets rejected, and the Provider must resubmit the Bill).

Much like filling out a 1040 for a tax refund, unscrupulous filers could put nearly anything on a 1040 and send it in for a false payment (refund) and it gets paid. Only later, if that return comes up for audit can the tax return filer get 'caught'. The system, when it comes to extracting cash from government, relies in large part on trust.

Good luck three years later proving that Mrs. Jones, who is now deceased, didn't actually have the more severe form of whatever affliction her Bills were coded with...

Most large organizations do not intentionally upcode (bad penalties for perpetrators of Medicare Fraud - and they *do* sometimes catch people), but the temptation is always there, especially for ever more cash-strapped facilities.


----------
"Crime is contagious. If the government becomes a law-breaker, it breeds contempt for law; it invites every man to become a law unto himself; it invites anarchy."
-USSC Justice Louis D. Brandeis: Dissenting Opinion in "Olmstead v. United States" (1928)

Reason: added
Mpilar
Posts: 5573
Incept: 2009-01-05
Gold
Nashville, TN
Report This As A Bad Post Add To Your Ignored User List
Quote:
Good Samaritan charged $439.90 for the drug; Aetna allowed $77.63. Somerset charged $6.52; Aetna paid $3.26.

Medicare pays 17 cents per dose.

****

----------
Every normal man must be tempted at times to spit on his hands, hoist the black flag, and begin to slit throats. H. L. Mencken
Godot
Posts: 670
Incept: 2008-03-03
Green
Oz
Report This As A Bad Post Add To Your Ignored User List
Tesla, if the surgeon was in the PPO network, the doc was contractually obligated to write off the overcharge.

By the way, I hope your kid is Okay.

----------
Cluelessinfl
Posts: 114
Incept: 2011-01-08

Florida East Coast
Report This As A Bad Post Add To Your Ignored User List
Why is it that when I get my car transmission repaired I receive an extremely detailed invoice listing every item even down to the number of bolts that were used but when I get a bill from a hospital it lists only "Procedure" and "Medication" with no details at all?

----------
Land of the Free my ass.
Sdbn
Posts: 387
Incept: 2009-09-13
Gold
Report This As A Bad Post Add To Your Ignored User List
I did not have maternity insurance when I had my fourth child in 2007. I got the bill from the hospital but with no payment envelope or billing address to which to send payment. I called the number on the bill and asked where to send payment and was told not to worry - they would be sending a payment plan booklet in a few weeks.

I said I wanted to pay the whole thing and there was a long pause and then I was asked to hold. She came back on and said that if I paid that day, she would take 70% off my bill and the co-pay for my daughter's bill. I asked around and was told that the hospitals around here were having trouble collecting from uninsured patients so had changed their policy for full payment.

The whole thing needs to come down! We now have 3 primary care docs around here that post prices in the waiting room and do not file insurance (they will provide the info for you to file, if you want). They have more business than they know what to do with.
Peterm99
Posts: 4981
Incept: 2009-03-21
Gold
SoCal
Report This As A Bad Post Add To Your Ignored User List
Sdbn wrote..
. . . around here . . .
Where is "here"?

----------
". . . the Constitution has died, the economy welters in irreversible decline, we have perpetual war, all power lies in the hands of the executive, the police are supreme, and a surveillance beyond Orwell’s imaginings falls into place." - Fred Reed
Sdbn
Posts: 387
Incept: 2009-09-13
Gold
Report This As A Bad Post Add To Your Ignored User List
Triangle area of North Carolina
Themortgagedude
Posts: 8841
Incept: 2007-12-17
Green
saint louis
Report This As A Bad Post Add To Your Ignored User List
And the Democrats who are supposed to fight for the little people let this go on why?

You don't have to answer that for me. I know several answers to the question.

----------
I'm already visualizing you with duct tape over your mouth.
Peterm99
Posts: 4981
Incept: 2009-03-21
Gold
SoCal
Report This As A Bad Post Add To Your Ignored User List
OK, thanks. To date, that model has not spread to where I am, AFAIK.

I find myself in a situation where my dentist wants to charge me several times what he used to accept as dental insurance payment when I had dental insurance.

----------
". . . the Constitution has died, the economy welters in irreversible decline, we have perpetual war, all power lies in the hands of the executive, the police are supreme, and a surveillance beyond Orwell’s imaginings falls into place." - Fred Reed
Login Register Top Blog Top Blog Topics FAQ
Showing Page 1 of 3  First123Last