"Depending on your viewpoint, one of two phenomena are occurring:
Hospitals and doctors are gaming the system to “upcode” every visit to a higher level, resulting in a higher bill OR
Electronica has simply allowed us to more legitimately capture what it is we do and bill accordingly–known as charge capture
Of course, the answer is somewhere in the middle–some are no doubt gaming, others likely just doing things better and reaping the rewards. The article noted, however, that the Department of Health and Human Services discovered that a mere 1,700 doctors nationwide (out of nearly a half million doctors in practice, or 0.4% of physicians) contributed $100 million of the increased charges. That amounts to sixty thousand dollars per physician in increased year-over-year charges. Do you really think a full time doctor could increase her billing that much for roughly the same amount of work, even allowing for perhaps a small inflation in patient volume or number of office visits?"
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I caught one doctor in California up-charging my visits from "15-minute followups" to "45-minute comprehensive"... I suspected for awhile, and I finally took a stopwatch in my pocket and timed it, and then looked at my copy of the bill when I stopped by the front desk to settle my copay... When I mentioned that I was not in there for a 45-minute visit, she tried to explain it away, and then I pulled out the stopwatch and showed them that 12:48 was the total time I spent with the doctor.
She got flustered, said it was a "mistake", and changed it...Then I wrote a letter to my insurance carrier and told them what was going on. I changed doctors the next week, but I read in the newspapers a few weeks later that that particular medical office was under investigation for fraud. So, I guess my whistle-blowing did some good.
You can figure that if one doctor does that to virtually every patient in a day, and the number of insurance companies involved make it difficult for them to look at his books and figure out that in an 8-hour day he couldn't possibly have provided 24-hour's worth of service...They get away with it all the time.
