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Newly Diagnosed Multiple Myeloma- Medical Billing Fraud???

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“Much of what we accept as legal in medical billing would be regarded as fraud in any other sector…bills for things that simply didn’t happen… charges that I would call fraudulent —are technically legal.”

I work with many newly diagnosed multiple myeloma patients (NDMM). NDMM patients who’s life with MM begins in the emergency room. Often a bone breaks on the golf course or in the shower. All the NDMM patient knows is that he/she is in excruciating pain. Their desire to make the pain stop exposes then to medical billing fraud that is legal medical billing fraud. In the emergency room of all places…

To some degree, this post falls into the “forewarned is forearmed” category.  If you began your life with multiple myeloma in the local emergency room and you’ve been saddled with an outrageous bill to stabilize your bone fracture, you may learn something by reading this post.

According to research, 95% of NDMM is diagnosed at stage II or III. Though statistics aren’t published, I think that this is the group of NDMM that is likely to begin life in the ER for bone or kidney damage.

Multiple myeloma can be an expensive cancer to manage. Though incurable, MM can be years in an out of remission populated with short, long-term and late stage side effects. Diagnostic testing alone can be a continual expense. And that is even with good medical insurance.

It’s important to point out that the writer below made a point of saying that her husband’s medical care was top notch, start to finish.

Experience has taught me that it is not the quality of medical care that’s the problem in the United States. It is how medical care is purchased and provided that is the problem.

Have you been diagnosed with multiple myeloma? What are your symptoms? Bone pain? Kidney damage? Scroll down the page, post a question or comment and I will reply to you ASAP.

Thank you,

David Emerson

  • MM Survivor
  • MM Cancer Coach
  • Director PeopleBeatingCancer

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“Much of what we accept as legal in medical billing would be regarded as fraud in any other sector…

Now, after a summer of firsthand experience — my husband was in a bike crash in July — it’s time to call out this fact head-on. Many of the Democratic candidates are talking about practical fixes for our high-priced health care system, and some legislated or regulated solutions to the maddening world of medical billing would be welcome…

The treatment he got via paramedics and in the emergency room and intensive care unit were great. The troubles began, as I knew they would, when the bills started arriving…

I will not even complain here about some of the crazy high charges: $182 for a basic blood test, $9,289 for two days in a room in intensive care, $20 for a pill that costs pennies at a pharmacy. We have great insurance, which negotiates these rates down. And at least Andrej got and benefited from those services

What I’m talking about here were the bills for things that simply didn’t happen, or only kind-of, sort-of happened, or were mislabeled as things they were not, or were so nebulously defined that I couldn’t figure out what we might be paying for.

To be clear, many of the charges that I would call fraudulent — maybe all of them — are technically legal (thanks sometimes to lobbying by providers), but that doesn’t make them right. And no one would accept them if they appeared on bills delivered by a contractor, or a lawyer or an auto mechanic…

1. Medical Swag-

“Companies are permitted by insurers to bill for “durable medical equipment,” stuff you receive for home use when you’re in the hospital or doctors’ office…The policy has also led to widespread abuse, with patients sent home with equipment they don’t need…

2. The Cover Charge-

The biggest single item on Andrej’s E.R. bill was a $7,143.99 trauma activation fee. What was that for, since every component of his care had been billed and billed handsomely?…

3. Impostor Billing

We received bills from doctors my husband never met. Some of these bills were understandable, like for the radiologist who read the scans. But others were for bedside treatment from people who never came anywhere near the bed to deliver the care…

4. The Drive-By

The day before Andrej left the hospital, a physical therapist visited and asked a few questions. From that brief encounter, the therapist noted “ambulation deficits, balance deficits, endurance deficits, pain-limiting function, transfer deficits.” That translated into a bill of $646.15 for what was recorded as a P.T. evaluation “1st session only (billable).” He said he was there for 30 minutes, but he was not. He said he walked Andrej up 10 steps with a stabilizing belt for assistance. He did not. There was no significant health service given. Just an appearance and some boxes checked on a form. It’s a phenomenon called drive-by doctoring…

5. The Enforced Upgrade

One Monday when Andrej was in pain and out of pills, the trauma doctor suggested we meet in the emergency room, because the trauma clinic was open only from 8 to 10:45 a.m. on Wednesdays and Thursdays.

So we met the trauma doctors in the E.R., and they talked to Andrej, who remained in his street clothes. They gave him a prescription. Because the interaction — which could have happened in the lobby — happened in the E.R., it resulted in an E.R. visit charge of $1,330…

My insurer paid for most of these questionable charges, though at discounted rates. But even a discounted payment for something that never really happened or didn’t need to happen or that we didn’t agree to have happen is still, according to common sense, a fraud.

Why do insurers pay? Partly because insurers have no way to know whether you got a particular item or service. But also because it’s not worth their time to investigate the millions of medical interactions they write checks for each day…

They’re “too big to care about you.” Electronic records, which auto-fill billing boxes, have probably made things worse. For example, the birth of a baby boy may automatically prompt a bill for a circumcision; having day surgery may prompt a check for sedation.

  • So what is the appropriate payment for swag I didn’t ask for,
  • outrageous cover charges,
  • stand-in doctors,
  • drive-by visits and faux surgery?

In some cases, zero; in others, far less than was paid. And yet, these are all everyday, normal experiences in today’s health care system, and they may be perfectly legal. If we want to tame the costs in our $3 trillion health system, we’ve got to rein in this behavior, which is fraud by any other name.”









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