Hospitals overcharge so they get some sort of "Percentage" from insurance. Insurance pays smaller percentages every year. It's a cycle that breaks the consumer of healthcare... the patients.

Hopeful that the system will change.

And wishful that justice can be served.
Seriously, WHEN will we have the balls to throw some of these cheating MoFos in PRISON?

Transparent government is FANTASTIC; we need LOTS MORE of it.

have uncovered over billing, fraudulent and erroneous billing, and have attached serious penalties to intentional wrongful billing. IIRC this is mostly done with hospitals. The next phase is to RAC audit providers, and to attach hospital billing to provider billing so if a hospital account is found erroneous the provider bill is automatically scrutinized too..This has been one error in the implementation of the RAC system, that is not attaching providers to the audit. The problem is that most hospitals are at the mercy of the providers, and providers don't really care if the hospital can bill or not. A lot of providers have been told by hospitals that there are problems with their documentation or the services they try to bill to no avail because the provider knows it won't effect their billing...once they are being audited and money is being taken back for their poor documentation and questionable practices more hospitals will fall into compliance.

Another problem with these RAC audits is that they are performed by contractors, not the .gov. These contractors are paid based on recovery from hospitals. There is an appeal process for the hospitals. Larger hospital groups with a lot of money challenge CMS, a long process, which often results in CMS losses. Smaller hospitals without the resources to fight often give up and don't challenge which further weakens their hospital. CMS doesn't care, they are looking for low hanging fruit. As it is now, the appeals process is at like a 3 year backlog, RAC audits are either going to have to stop or there will need to be guidelines putting these audits only on the most egregious violators.

This is a massive problem. It is good that the problem is being attempted, there are still a lot of problems.

As for the article, these billing discrepancies don't really effect CMS or medicare, because medicare will only pay so much for these procedures...these effect the private insurance companies based on their contract with the hospital. The larger balances after medicare pays result in higher payments from the insurance provider which drives the cost of insurance up. I have long believed the policy of contracting with insurance companies for lower rates for services is wrong in the context of healthcare..why should an uninsured person be responsible for more than Blue Cross for the same medically necessary procedure? It's wrong.

and making it very difficult for the non profit hospices that are not giving and billing for services for which people are not eligible.
The hospice is Vitas. They are owned by Rota rooter.

This comes as no surprise to me when I read this. You know it was just a matter of time before hospitals started to totally screw people with costs. I recently was slated for a minor heart test which would have taken 15-20 minutes max. My cardiologist's office used to do it and bill me within reason. Well they moved some of their testing apparatus to the hospital next door when they were sold/bought by a system here. When the woman told me it would cost over $1,400 for this procedure I said screw it, I'd go to another facility which does the same tests. I did a co-pay and also was billed a fraction of what the hospital was going to charge. My doctor told me hospitals are starting to do these kinds of things. A relative had a procedure which was done on an out-patient basis at a hospital and was billed nearly $4,000. Luckily we have some insurance and it cut part of the costs but what if we didn't? I know all these Republicans and Tea Party types are against any kind of health care plan by the government, but let's face facts. People are getting it shoved up you know where! Let's end this madness.

One factor to include is how much a hospital loses by caring for indigent people.

Some hospitals are just greedy. But some may try to make up their losses for caring for very poor people without insurance by charging more for those covered with insurance.

I don't know. But there may be more to this story than meets the eye.

If a facility is in a very urban area and deals with homeless people and drug addicts and shootings, etc., its expenses and its costs may be very different from a hospital in a high-end neighborhood. And of course, the doctors in a hospital in a high-end neighborhood may be earning more and thus charging more.

The numbers tell part of the story, but probably not all of it.

Hospitals trying to make a profit (or break even) through creative accounting. It is a complex issue due to many many factors such as low reimbursement from Medicare, low reimbursement from negotiated private insurance, trying to make up money lost on uninsured.

Whether the Affordable Care Act addresses a lot of these issues remains to be seen as it is more widely implemented. The AFA mainly provides subsidies to private insurance which while it might make health insurance more available, it is not really addressing the cost.

The difference between what is charged and what is written off surely is documented somewhere and allows the hospital to show what a 'great deal' of discounting that are doing, when it fact it bears no relation to reality.

The rest of us didn't.

That included time spent in traction.

These days they would take your house.

This is a national scandal. Unequal application of the laws.

I've met several doctors who were absolute crooks.

It is unfair, unethical, unjust, unequal, and abusive of those who are vulnerable.

I wish I could sue every one of them but there are no laws to prevent it, except
perhaps mental distress, emotional harm, and holding them up to public scrutiny.

Shameful. And I don't see how Obamacare fixes this problem by rewarding the system
with eternal payments.

SHAMEFUL!

Diagnosis Related Groupers makes the original billed amount irrelevant. These DRGs determine the hospital's payment based solely on the patient diagnosis on discharge as reported by the hospital. This means that in some cases a hospital can actually be paid more than the actual billed charges. Hospitals have been caught "upcoding" the severity of the patient's condition to get a higher Medicare reimbursement and are only caught through audits of the medical records. They know that a very small percentage of records will be audited so unscrupulous hospitals are willing to take the risk. The folks who are really harmed by these excessive charges are the uninsured who are charged the full retail rates and employers and their employees who have commercials plans where reimbursement is often based on a discounted retail rate and not DRGs. These discounts will vary greatly depending on who the insurance carrier is and what their share of the market is in a particular geographic area.

when the money they're charging doesn't materialize.

IOW, they charge near $30K for an emergency appendectomy with a 36 hour stay in the hospital (happened to me last year) even though they know they'll receive no more than, say, $10K from the insurance company and the co-pays from the patient (in my case, $2K).

They then 'settle' for the $10K they received, while 'writing off' the other $20K they 'couldn't collect' that they say they were 'owed' under the circumstances.

I'm thoroughly convinced, however, that if I didn't have insurance, they'd have billed me for the entire $30K they say my visit 'cost' ... and then when they couldn't get it, they'd have written it off, whilst still leaving me on the hook with some 'collection agency' for the entire amount.

I was glad to have insurance, let there be no doubt, but ... the whole operation of these places, and their insurance company colluders, is an obvious scam.

Made a compelling argument for how and why Medicare works.

http://www.time.com/time/magazine/article/0,9171,2136864,00.html

he was taken to the hospital. he was there less than 24 hours and they charged almost $24,000 for room and board. then of course, there were additional charges for doctors and tests. he was transferred to another hospital specializing in neurology. he spent 10 days there and the room and board was $117,000 -- not including doctors and tests. do the math. the room and board came to 11,700 per day opposed to almost $24,000 per day.

Too bad you don't live in Europe of Canada.

there were deductibles and co-pays. we did have a max of $6,000 per person out of pocket. he passed away 3 months later. i've never really added up the bills to see what the actual cost of his illness was but i know it was high.

I posted about this elsewhere recently, but I got to tell Obama face to face about two hospital stays I had in 2011. Both 3 days, both involving operations by specialists, both in top hospitals in their respective areas. The one in Düsseldorf cost €9000, or about $12000. The one in Dallas cost $36,500. That was "discounted" for the insurance company (not to me) to $26,500, and my deductible was 10% of that. I told him flat out that something was wrong with that picture, and he made sure one of his guys followed up with me. I think the American institutions would rather send a cruise missile to the White House than give up their lucrative racket, but their dirty secret is out, and the man in the Oval Office knows it.

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they have been doing it for a very long time. It's called pad the fees!

BUT I think there are other issues that should be measured along with cost such as success rate, mortality rate, rate of re-hospitalization, health of the patient, etc. Maybe the hospital that charges only $7k has a higher mortality rate then the hospital that charges $99k. I'm not saying that this is true but I think that more factors should be measured than just cost. Now if they are saying that one hospital charges $100 for surgical scrubs and another only charges $15 for the same set of scrubs or one hospital charges $300 for an MRI and another hospital charges $1500 for the same MRI then I totally share the outrage.

This cost issue feels a little like the "standardized testing" of the healthcare industry to me.