My General Practictioner bills my insurance more than my cardiologist for office visits. The sad part is that the cardiologist spend more time with me. I guess he has a different business model. /forums/images/graemlins/crazy.gif
Insurance fraud
- Thread starter Taylortractornut
- Start date
- Views: 1885
cowboydoc
Super Member
- Joined
- Dec 23, 2000
- Messages
- 6,725
- Tractor
- JD 8320 MFWD, JD 6415 MFWD, FEL, and cab, John Deere MFWD 4600, John Deere 4020, John Deere 4430, John Deere 455 mower, Deutz, and Gehl 4610 perkins skidsteer
this country is in desparate need of a complete overhaul of the health care system to include doctors, hospitals, and insurance companies
You won't get any argument from me Bird. It's a mess all the way around for sure. But when you have to pay $8k a month just for malpractice insurance the money has to come from somewhere.
You won't get any argument from me Bird. It's a mess all the way around for sure. But when you have to pay $8k a month just for malpractice insurance the money has to come from somewhere.
Anonymous Poster
Epic Contributor
- Joined
- Sep 27, 2005
- Messages
- 29,678
Cowboydoc, Yup, that's a chunk of money for insurance, but what is the GROSS income 8k is based on?
There's plenty of guilt to go around in the medical insurance business, and nobody's innocent.
Patients demand instant cure, and insist on antibiotics for every sniffle, cause they were conditioned to that level of care by a system that was Fee for Service. Most of them had no idea what the cost was, and didn't care cause they had FREE health insurance from their employer.
Hospitals, well, Fee for Service incentivised creative billing, and they got real good at it.
Doctors ~ well, I've seen some who stood in the hall outside a patient room discussing their golf game and then made a notation in the chart, so they could bill for "consultation". We all know there are medicaid mill docs, and thousands of other shining examples of billing for services not delivered.
Carriers ~ wonderful organizations designed to make money by moving money. Years ago, Congressional hearings learned the Blues did not qualify for tax exempt status, and that it should be revoked, but Congress didn't dare cause the Blues could and would blackmail the country.
Drug Manufacturers ~ the absolute biggest bull artists on the face of the planet, who now occupy more TV commercial time hawking their product to the public than any other advertiser, and charge more for their product in this country than they do in Canada, and have the audascity to claim a Canadian Celebrex is different from a US Celebrex.
I happen to be in the position of seeing the system from quite a few angles, and nobody has clean hands. In New York, taxpayers fund State Insurance Fraud Investigation, and strange as it may seem, it's legal for a carrier to defraud an insured, but it's criminal for the insured to defraud a carrier. That's an interesting concept in itself.
I've watched the health insurance business since the 1950s, when people considered themselves fortunate to have Hospital Insurance, and especially fortunate if the employer paid for it. Back then, people paid their own doctor bill when they went to the doctor, usually $3.00 for the doc plus a couple bucks more for a shot.
I've followed that system grow itself to total health care, where the person getting the care pays nothing, to co-pay, to the current system. What has evolved is akin to colission insurance for a car without any deductable, and it cannot work.
The only party in the current equasion that is making money is the carriers, and they are making ALL the money. Patients are receiving lowered levels of care, docs are forced to see more patients per hour, hospital staffing and patient care is being gutted, and the Carriers are getting rich.
A fey years back, NY State forced carriers to develope a plan that would prevent lower income people from winding up on Welfare Medicine, because the State didn't want the bill, and amazingly, the carriers did.
It's called ValuMed, and pays all hospital expenses, for a premium that is currently around $37- per month. Oddly, the premium has dropped from the initial premium of $43- a month, and the system is working. The reason the system works, there is a $250- patient payment for the initial hospital admission.
Is the current system sustainable, I doubt it. Will a government backed single payer system fix the problem, Never. The government can't even operate Social Security.
Malpractice premiums are based solely on the carrier's bottom line, and that's a function of not only the quality of medicine practiced, but the stock market as well. Carriers DON'T loose money, and never will; Nor do Doctors clean their own house. There are plenty of practitioners who should NOT be practicing medicine, and their collegue's know who they are, but won't cull them out of the profession.
Like I said back at the beginning, there's plenty of guilt to go around.
There's plenty of guilt to go around in the medical insurance business, and nobody's innocent.
Patients demand instant cure, and insist on antibiotics for every sniffle, cause they were conditioned to that level of care by a system that was Fee for Service. Most of them had no idea what the cost was, and didn't care cause they had FREE health insurance from their employer.
Hospitals, well, Fee for Service incentivised creative billing, and they got real good at it.
Doctors ~ well, I've seen some who stood in the hall outside a patient room discussing their golf game and then made a notation in the chart, so they could bill for "consultation". We all know there are medicaid mill docs, and thousands of other shining examples of billing for services not delivered.
Carriers ~ wonderful organizations designed to make money by moving money. Years ago, Congressional hearings learned the Blues did not qualify for tax exempt status, and that it should be revoked, but Congress didn't dare cause the Blues could and would blackmail the country.
Drug Manufacturers ~ the absolute biggest bull artists on the face of the planet, who now occupy more TV commercial time hawking their product to the public than any other advertiser, and charge more for their product in this country than they do in Canada, and have the audascity to claim a Canadian Celebrex is different from a US Celebrex.
I happen to be in the position of seeing the system from quite a few angles, and nobody has clean hands. In New York, taxpayers fund State Insurance Fraud Investigation, and strange as it may seem, it's legal for a carrier to defraud an insured, but it's criminal for the insured to defraud a carrier. That's an interesting concept in itself.
I've watched the health insurance business since the 1950s, when people considered themselves fortunate to have Hospital Insurance, and especially fortunate if the employer paid for it. Back then, people paid their own doctor bill when they went to the doctor, usually $3.00 for the doc plus a couple bucks more for a shot.
I've followed that system grow itself to total health care, where the person getting the care pays nothing, to co-pay, to the current system. What has evolved is akin to colission insurance for a car without any deductable, and it cannot work.
The only party in the current equasion that is making money is the carriers, and they are making ALL the money. Patients are receiving lowered levels of care, docs are forced to see more patients per hour, hospital staffing and patient care is being gutted, and the Carriers are getting rich.
A fey years back, NY State forced carriers to develope a plan that would prevent lower income people from winding up on Welfare Medicine, because the State didn't want the bill, and amazingly, the carriers did.
It's called ValuMed, and pays all hospital expenses, for a premium that is currently around $37- per month. Oddly, the premium has dropped from the initial premium of $43- a month, and the system is working. The reason the system works, there is a $250- patient payment for the initial hospital admission.
Is the current system sustainable, I doubt it. Will a government backed single payer system fix the problem, Never. The government can't even operate Social Security.
Malpractice premiums are based solely on the carrier's bottom line, and that's a function of not only the quality of medicine practiced, but the stock market as well. Carriers DON'T loose money, and never will; Nor do Doctors clean their own house. There are plenty of practitioners who should NOT be practicing medicine, and their collegue's know who they are, but won't cull them out of the profession.
Like I said back at the beginning, there's plenty of guilt to go around.
brad_oatley
Silver Member
Franz' question pertaining to gross is what I've been wondering also. Are the underwriters premiums THAT prohibitive to cause doctors to close their practices? I own an HVAC and plumbing contracting and service company. Insurance runs $17,000 a month. Prices get raised and we compete harder for market share.
Maybe it's time Doctors raised their prices and competed for market share.
Capitalist idea!
Maybe it's time Doctors raised their prices and competed for market share.
Capitalist idea!
Bird
Rest in Peace
</font><font color="blue" class="small">( have to pay $8k a month just for malpractice insurance )</font>
Yep, that's ridiculous, and I understand some specialties are paying more than twice that amount, in Texas at least. /forums/images/graemlins/frown.gif It's a complicated issue with no simple cures, but I do think it could be cured if our legislators on both state and national levels would just get started and do it. I can understand doctors and hospitals having to charge high prices, but I don't understand billing for things that were not provided, I don't understand paying hospital administrators 2 to 4 million dollar a year salaries, supposedly because they cut expenses when the cuts were actually cutting service, and I don't understand billing insurance companies for two to ten times the amount that they know the insurance company will pay. I suppose if a person doesn't have insurance, and isn't on Medicaid, then they just get gouged with the exorbitant prices.
And of course there's plenty of blame to go around; doctors, hospitals, insurance companies, pharmaceutical companies, medical equipment manufacturers, legislators, lawyers, judges, goofy jurors, and the patients.
Yep, that's ridiculous, and I understand some specialties are paying more than twice that amount, in Texas at least. /forums/images/graemlins/frown.gif It's a complicated issue with no simple cures, but I do think it could be cured if our legislators on both state and national levels would just get started and do it. I can understand doctors and hospitals having to charge high prices, but I don't understand billing for things that were not provided, I don't understand paying hospital administrators 2 to 4 million dollar a year salaries, supposedly because they cut expenses when the cuts were actually cutting service, and I don't understand billing insurance companies for two to ten times the amount that they know the insurance company will pay. I suppose if a person doesn't have insurance, and isn't on Medicaid, then they just get gouged with the exorbitant prices.
And of course there's plenty of blame to go around; doctors, hospitals, insurance companies, pharmaceutical companies, medical equipment manufacturers, legislators, lawyers, judges, goofy jurors, and the patients.
cowboydoc
Super Member
- Joined
- Dec 23, 2000
- Messages
- 6,725
- Tractor
- JD 8320 MFWD, JD 6415 MFWD, FEL, and cab, John Deere MFWD 4600, John Deere 4020, John Deere 4430, John Deere 455 mower, Deutz, and Gehl 4610 perkins skidsteer
Let me clear one thing up Franz and that is that your malpractice ins. is NOT based on your gross income! They don't care if you make 100k gross a year or 5 million gross a year. It's based on your specialty, hours in practice, years in practice, and if you have had any claims. If you have had claims oh the sky is the limit. As to your question about how much of gross is this. It's anywhere from a low of 25% up to 75%.
Also like the heating and plumbing industry we cannot raise our prices. Well we can but ins. won't pay them. As you guys have seen ins. will cut our fees based on what the RCS value is for that service. It's a big game no doubt that the ins. comp. have created. The reason you see so many charges is because if we don't charge for every little thing then the next year the ins. comp. will say that what we charge for is no longer needed. Insurance is a complete disaster and all the rules favor the ins. comp. The ins. industry can get together and talk about prices but we as doctors can't.
Very few hosp. operate in the black. I have no problem with an administrator making a couple mill. a year. They are the CEO of a corporation. If you want good people you're going to have to pay for them.
You hit it on the head Franz when you said that people expect to get well immediately. Very few people actually physically work anymore. They won't follow your advice for exercise and diet. Everyone just wants a pill or a surgery to fix it. Nobody wants to take resp. for their healthcare. Then if something does happen the public calls for a lynching.
There are very few docs that aren't capable. If you are in the corp. world you can be a drug addict, alcoholic, felon, etc. and you are mandated by most govt. rules that you are mentally incap. and need all the free help your comp. can give. Docs are held to a very high standard. For the most part these docs are rooted out. We try very hard to get them back on track. Whether it be inadeq. skills or a personal problem. Many docs do lose their license. And many do make mistakes just like every profession. It's just not in every prof. that if you make one mistake you pay for it for the rest of your life.
It's a complicated system and way beyond the scope of this forum. Certainly there are problems all the way down the line from the patients to the insurance company with everyone in between included. Some of what has been said here is completely off base and some is right on. How many of you guys on the job ever took an extra half hour lunch or discussed something else at the water cooler or were on the computer at work when your comp. was paying for it? Then you talk about a doc discussing his golf game after he's seen a patient? Double standards for sure. Nope docs are not perfect by any means. Yep sometimes you get charged for something that wasn't done. Just like most of you have charged for your services, took a company expense that wasn't an expense, took a few supplies home, etc. We all do the same things at one time or another. Not saying it's exactly right but sometimes it does happen. /forums/images/graemlins/wink.gif
Also like the heating and plumbing industry we cannot raise our prices. Well we can but ins. won't pay them. As you guys have seen ins. will cut our fees based on what the RCS value is for that service. It's a big game no doubt that the ins. comp. have created. The reason you see so many charges is because if we don't charge for every little thing then the next year the ins. comp. will say that what we charge for is no longer needed. Insurance is a complete disaster and all the rules favor the ins. comp. The ins. industry can get together and talk about prices but we as doctors can't.
Very few hosp. operate in the black. I have no problem with an administrator making a couple mill. a year. They are the CEO of a corporation. If you want good people you're going to have to pay for them.
You hit it on the head Franz when you said that people expect to get well immediately. Very few people actually physically work anymore. They won't follow your advice for exercise and diet. Everyone just wants a pill or a surgery to fix it. Nobody wants to take resp. for their healthcare. Then if something does happen the public calls for a lynching.
There are very few docs that aren't capable. If you are in the corp. world you can be a drug addict, alcoholic, felon, etc. and you are mandated by most govt. rules that you are mentally incap. and need all the free help your comp. can give. Docs are held to a very high standard. For the most part these docs are rooted out. We try very hard to get them back on track. Whether it be inadeq. skills or a personal problem. Many docs do lose their license. And many do make mistakes just like every profession. It's just not in every prof. that if you make one mistake you pay for it for the rest of your life.
It's a complicated system and way beyond the scope of this forum. Certainly there are problems all the way down the line from the patients to the insurance company with everyone in between included. Some of what has been said here is completely off base and some is right on. How many of you guys on the job ever took an extra half hour lunch or discussed something else at the water cooler or were on the computer at work when your comp. was paying for it? Then you talk about a doc discussing his golf game after he's seen a patient? Double standards for sure. Nope docs are not perfect by any means. Yep sometimes you get charged for something that wasn't done. Just like most of you have charged for your services, took a company expense that wasn't an expense, took a few supplies home, etc. We all do the same things at one time or another. Not saying it's exactly right but sometimes it does happen. /forums/images/graemlins/wink.gif
Egon
Epic Contributor
Not being a wise man the formation and installation of a, working for all, medicare system is well beyond me.
However I do know that the Doctor should not have to spend a day at his practice after having spent half the night on emergency calls. He should also not have to work over 40? hours a week. He may have a family that likes his company for more than a passing moment at breakfast or supper and requires the need for relaxation as do most of us. There should also be time allowed for updating his knowledge base as these bases expand so that he can meet the proffessional standards of his peer group. Neither should he have to waste valuable time on administrative duties as this is not what his primary knowledge base is devoted to.
I also know the Doctor that preformed Arthroscopic surgery on my left knee several days ago did an excellent job as walking is now pain free.
Nuff said .
Egon
However I do know that the Doctor should not have to spend a day at his practice after having spent half the night on emergency calls. He should also not have to work over 40? hours a week. He may have a family that likes his company for more than a passing moment at breakfast or supper and requires the need for relaxation as do most of us. There should also be time allowed for updating his knowledge base as these bases expand so that he can meet the proffessional standards of his peer group. Neither should he have to waste valuable time on administrative duties as this is not what his primary knowledge base is devoted to.
I also know the Doctor that preformed Arthroscopic surgery on my left knee several days ago did an excellent job as walking is now pain free.
Nuff said .
Egon
Anonymous Poster
Epic Contributor
- Joined
- Sep 27, 2005
- Messages
- 29,678
Cowboydoc, as we both know, different states, different rules. In NY, it is entirely possible for a bad doc to retire before the State Med Board begins processing a complaint filed against him. Where you are, hopefully things are different. The one big glitch in the system is that a doc can and many do, jump from state to state, one step ahead of license revocation.
In NY, carriers play a little game where they use docs that should have been put to pasture years before an expert witnesses, probably to pay off malpractice awards. I've personally been sent to be examined by a CLOWN who was a non practicing gynecologist, so a carroer could disallow an ongoing back injury claim. I assure one and all I am NOT female. Since I was wise to the system, I arrived for the examination with a cameraman and video camera. Oddly, the doc didn't want to examine me, and the carrier decided to keep paying the claim.
As to your misreading of the folf game incident, "Then you talk about a doc discussing his golf game after he's seen a patient? " the clown who billed for the consult wasn't the patient's doctor, hadn't seen the patient, and the providing physician was highly pi$$#@ when he was made aware of the situation. Oddly, said billing consultant arrived at a large settlement with several carriers a few months later, and moved on to a new state.
I have no problem with a doctor getting paid for his work, but I'm dammed if somebody gets a free ride cause he knows how to beat the system. When my Old man was in the hospital, he kept a record of docs who saw him in any capacity, and oddly, several showed up on the bills that arrived post discharge for "consultation". I found it necessary to get into the deal because when he called he was told pay up or we will sue you. Oddly, these same people had an entirely different attitude when I arrived at their office for a talk. Naw, it couldn't have had anything to do with me doing my homework at hospital records first, or talking to his primary doc.
My orthopedic surgeon retired a couple years ago, and told me he felt sorry for the young docs coming up, cause they would never make the money he had in their lifetime. He retired with over 3 million owed to him by people who couldn't pay, and could afford to write it off, rather than send collectors out to gouge people, cause he figured he had been given a gift by God, and owed something for that gift. I guess you'd call him one of the good guys.
I also know "docs" who don't belong anyplace other than mucking out a stable, both for the way they practice, and for their level of competence.
Carriers are the only ones making out in the current climate, and that isn't just limited to the medical profession. Litigators have learned to shotgun complaints, and will sue everyone involved in any transaction, and carriers make litigators rich. A carrier will spend $50k on litigation rather than settle a claim for $50k, because they have a policy of being harda$$.
In the 7th judicial district of NY, a malpractice complaint cannot even get to court without a panel of 2 docs and 2 insurance men signing off on it, so very few get that far. Does this result in lower malpractice rates, NO way.
Do we have a shortage of Docs here, no, but we sure have a shortage of competent top notch doctors.
We also have 1 major hospital that is engaging in predatory takeover or kill of other hospitals in town, because they want to be the ONLY provider.
Oh yea, it's a wonderful mess.
In NY, carriers play a little game where they use docs that should have been put to pasture years before an expert witnesses, probably to pay off malpractice awards. I've personally been sent to be examined by a CLOWN who was a non practicing gynecologist, so a carroer could disallow an ongoing back injury claim. I assure one and all I am NOT female. Since I was wise to the system, I arrived for the examination with a cameraman and video camera. Oddly, the doc didn't want to examine me, and the carrier decided to keep paying the claim.
As to your misreading of the folf game incident, "Then you talk about a doc discussing his golf game after he's seen a patient? " the clown who billed for the consult wasn't the patient's doctor, hadn't seen the patient, and the providing physician was highly pi$$#@ when he was made aware of the situation. Oddly, said billing consultant arrived at a large settlement with several carriers a few months later, and moved on to a new state.
I have no problem with a doctor getting paid for his work, but I'm dammed if somebody gets a free ride cause he knows how to beat the system. When my Old man was in the hospital, he kept a record of docs who saw him in any capacity, and oddly, several showed up on the bills that arrived post discharge for "consultation". I found it necessary to get into the deal because when he called he was told pay up or we will sue you. Oddly, these same people had an entirely different attitude when I arrived at their office for a talk. Naw, it couldn't have had anything to do with me doing my homework at hospital records first, or talking to his primary doc.
My orthopedic surgeon retired a couple years ago, and told me he felt sorry for the young docs coming up, cause they would never make the money he had in their lifetime. He retired with over 3 million owed to him by people who couldn't pay, and could afford to write it off, rather than send collectors out to gouge people, cause he figured he had been given a gift by God, and owed something for that gift. I guess you'd call him one of the good guys.
I also know "docs" who don't belong anyplace other than mucking out a stable, both for the way they practice, and for their level of competence.
Carriers are the only ones making out in the current climate, and that isn't just limited to the medical profession. Litigators have learned to shotgun complaints, and will sue everyone involved in any transaction, and carriers make litigators rich. A carrier will spend $50k on litigation rather than settle a claim for $50k, because they have a policy of being harda$$.
In the 7th judicial district of NY, a malpractice complaint cannot even get to court without a panel of 2 docs and 2 insurance men signing off on it, so very few get that far. Does this result in lower malpractice rates, NO way.
Do we have a shortage of Docs here, no, but we sure have a shortage of competent top notch doctors.
We also have 1 major hospital that is engaging in predatory takeover or kill of other hospitals in town, because they want to be the ONLY provider.
Oh yea, it's a wonderful mess.