Abusive Medical Billing: What Is It and How to Stop It

This Video Addresses Abusive Medical Billing by a Radiologist for Reading an MRI. Abuse is Part of the Larger Issue of Fraud, Waste and Abuse in Medical Claims for Employee Health Plans.

The Radiologist Charged $4,453 for the 5-Min Task of Interpreting MRI Images.

Eventually, the Radiology Office Offered an 80% Discount Down to $891. This is Still Almost 8X the Medicare Rate of $118.

Upon Further Questioning, the Radiology Director of Accounting Said They Had Made a Mistake Going As Far Back as 2019 in Charging so Much and That They Usually Try to Bill ONLY 10X the Medicare Rate... Rather Than 40X the Medicare Rate!

The Director of Accounting Said the Reason They Bill So Much is Because Several of Their Insurance Contracts Still Pay Them a Percent of Billed Charges... Therefore, the More the Radiology Practice Bills, the More Money They Make.

The Incorrect $4,453 is Lower than the $5,000 to $10,000 Threshold for Most Insurance Carriers to Audit a Claim.

So for Over a Year, this Radiology Practice Has Been Paid Handsomely for Their Mistake... at the Expense of Patients and Employers Like You.

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