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blorpblorpbloop t1_iujryag wrote

>discover that the hospital charged nearly $7,000 for a procedure that was never performed.

How is this not straight up fraud at grand-theft levels?

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upboatsallaround t1_iuk4gpf wrote

It absolutely is, but when you have the bribes lobbying power these insurance companies do... it magically isn't.

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Jeutnarg t1_iujwkru wrote

It's not legally fraud if it's a simple accident. In my state, it has to be done "intentionally, knowingly, recklessly, or with criminal negligence" to count like that. That's just one state, but it's probably similar in most US jurisdictions.

Now, if they try to keep it after becoming fully aware of the situation, you could be looking at a crime.

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PA2SK t1_iuk5c7t wrote

The thing is it probably is intentional, or at the very least willfully ignorant, but proving that would be next to impossible without a whistleblower. It seems like hospitals routinely issue outrageous bills and then chalk it up to a "mistake" when they're called out on it. The strategy seems to be to pad the bill as much as possible and then let the insurance company/patient argue it down if they're so inclined.

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[deleted] t1_iuk4jw7 wrote

[removed]

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GoBanana42 t1_iuk7kr0 wrote

A mistake or typo on a bill is not the same as ignorance of the law.

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Unsteady_Tempo t1_iuk870i wrote

See also discrimination. A business can have a pattern of discrimination due to institutionalized policies and practices and not because any one individual is making a conscious, nefarious decision to discriminate against a protected class

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Warmstar219 t1_iuk5obw wrote

It is. But people with money play by a different set of rules.

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Unsteady_Tempo t1_iuk7v6q wrote

It should be, if there's a pattern of it. The hospital admitted they coded it as a treatment of a fracture rather than a stabilizing splint. The patient didn't receive treatment of the fracture until the following day at a different, unaffiliated provider.

Shah received a letter from the hospital dated May 27 of this year, saying it had reviewed the records and discovered the bill was inappropriately coded: The hospital should have used the code for a splint, not a treatment. A month later, Shah got a new bill with a patient balance of $1,214.91 — $2,100 less than the original balance.

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