Tuesday, June 19, 2018

Astounding Story of Fraud and Dysfunction in Our Healthcare System

Health insurance giant Anthem Blue Cross has filed suit against Sonoma West Medical Center, accusing the Sebastopol hospital of conspiring with an out-of-state medical laboratory in a billing scheme that Anthem claims defrauded it and its members of $16 million. 
The lawsuit, filed June 1 in U.S. District Court, alleges that Sonoma West Medical Center knowingly allowed Florida-based Reliance Labs to use it as a drug testing front. Reliance allegedly used the hospital provider’s credentials to bill for testing on urine samples taken from Anthem members who were not local patients and had never visited the Sebastopol facility, according to the lawsuit. 
Billing through the hospital allowed the “co-conspirators” — Reliance and Sonoma West Medical Center — to increase insurance payments for each drug test by 100-fold, the lawsuit said. 
“With that simple deception, they could transform a $32 claim into a $3,500 claim, because hospitals were paid as a function of their billed charges,” the lawsuit claims. ...
Full story here, absolutely worth the time to read.