Fraud, politics and health-care reform

Filed Under: Uncategorized

Fraud, politics and health-care reform

Fraud and Bribery: “The California Public Employees’ Retirement System is negotiating a lucrative pharmacy benefits management contract with Caremark Rx Inc., a company being sued for defrauding the pension fund of tens of millions of dollars. …In March, the CalPERS board canceled negotiations with Medco Health Solutions Inc., which had been the front-runner for the […]

Test charges: $401 = $24.80

Filed Under: Costs, Health plans, Patients

Test charges: $401 = $24.80

It’s not the first time medical bills in my family have seemed really confusing. Take a look at these two bills, for the same procedure, performed not long ago. The top one is from the provider for the actual test, a blood test at a lab. The charge was $401, the mysterious “adjustment” $376.20, leaving […]

Aetna sues in New Jersey, Pt. 2

Aetna sues in New Jersey, Pt. 2

The Aetna lawsuit in New Jersey seemed so puzzling that we continued reporting on it, following links. Why would Aetna pay such ridiculous rates, including a payment of $56,980 for a bedside consultation and “$59,490 for an ultrasound that typically costs $74”? That just seems absurd; we have a hard time getting $23.40 out of […]

Finding the money

Filed Under: Providers, Regulators

Finding the money

Groundbreaking reporting on the health-care payments system this year came from The Wall Street Journal.  The government is the largest payer of medical claims, and The Journal has made good use of what data it has to identify providers who have performed an outsize number of procedures, collected an outsize amount of money, and generally […]

A word about us

Filed Under: Uncategorized

A word about us

We’re in “soft launch” mode, working to build the site and make it better. While it’s clearly a work in progress, we wanted to note that the founding ethos here is the Lean Startup mode, in which we try to move fast and work toward being perfect, not wait to do something until it’s perfect. […]

An ultrasound: $74 or $59,490?

An ultrasound: $74 or $59,490?

Aetna is unhappy: it received high bills from providers and paid them, and now it’s suing. “Aetna Inc. (AET) is suing six New Jersey doctors over medical bills it calls ‘unconscionable,’ including $56,980 for a bedside consultation and $59,490 for an ultrasound that typically costs $74,” Peter Waldman wrote on Bloomberg News on March 24. […]

Prices and reality

Filed Under: Uncategorized

Prices and reality

It seems sometimes that the medical system is a collection of people telling whoppers to each other. Health-care providers tell the insurance company that a procedure or a thing costs a bunch of money. The insurance company tells the consumer that the price is something completely different. The doctor tells the patient that she doesn’t […]

Comparison shopping, rationing, hospital bills and more

Filed Under: Uncategorized

Comparison shopping, rationing, hospital bills and more

There’s an app for that: “Picture it: Your doctor tells you that you need an MRI. Okeydoke, you say, pulling out your smartphone and typing in your zipcode. Up pop the 20 closest high-quality imaging centers, and you choose the most convenient. That’s my visualization based on a casual mention that Blue Cross Blue Shield chief Andrew Dreyfus made last week of a new app now in development. ‘We’re pretty close to delivering this,’ he told a health reform forum at Suffolk.” Carey Goldberg, CommonHealth blogger at WBUR. More.