Health cost fraud: The Most Wanted

Filed Under: Costs, Health plans

862862
Health cost fraud: The Most Wanted

This is for real: a Web site from the Health and Human Services Department showing the most wanted fugitives committing Medicare and Medicaid fraud. For example: “Carlos, Luis, and Jose Benitez, commonly referred to as the Benitez brothers, allegedly schemed to submit false and fraudulent claims to Medicare, pocketing approximately $110 million from Medicare, according […]

Outsourcing help on health costs

Filed Under: Costs, Patients

857

Two health-care cost resources came across our radar today. OffYourDesk.net announces  “Dealing with health insurance paperwork can be frustrating and time-consuming, so why not let us do it?  We’ll handle every aspect of your health insurance claims, so you get the maximum reimbursement you deserve quickly, easily and pain-free.” It costs $195 a year, or […]

Fraud, politics and health-care reform

Filed Under: Uncategorized

825825
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

802802
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

676676
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

737737
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

727727
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?

646646
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. […]