Predatory ER Overcharges and Hospital Overbilling Has to Stop

Atlantis, FLWith hospitals, you really have to wonder if the inmates are running the penitentiary. Or at the very least, the business office. With no disrespect to the skilled doctors and nurses who are on the front lines in the emergency rooms of the nation, and against sometimes formidable odds calmly patching up our various hurts in the midst of constant panic (from the patient), whomever is responsible for ER overcharges for services may be a good candidate to get their own head examined.

Patients are hurting in the process, often having to pay exorbitant fees or co-payments that only add to the stress of a patient’s original injury. Little wonder that so many patients are turning into plaintiffs and filing lawsuits.

The moral and Hippocratic oaths of hospitals and medical practitioners hold that patients in need should never be denied critical care just because of an inability to pay. Admittedly, when hospitals treat poor Americans with little or no funds to pay the bill, they have to absorb the cost or overage of treating that patient.

However, according to various health care advocates, hospitals make up the shortfall by overcharging uninsured patrons with means or patients who carry insurance.

One can well imagine the challenges hospitals face to stay afloat. However, is this fair to the insured or affluent patient to inflate the cost of an emergency room procedure to almost 40 times the posted rate for that procedure?

Is it legal?

One lawsuit in Florida seeking class-action status asks those very questions, on both counts. In particular, two patients treated at JFK Medical Center in Atlantis, Florida, following separate automobile accidents allege procedures administered for their care in the emergency room were grossly inflated and the billed costs unlawful.

According to court records, one patient was charged $6,404 for a CT scan of the brain that would normally cost $163.96. The same patient was billed $5,900 for a CT scan of the spine, $3,359 for a lumbar spine X-ray and $2,222 for a thoracic spine X-ray. Those procedures, according to South Florida Medicare, carry standard “customary and reasonable” rates of $213.14, $51 and $38 respectively.

Fees for service can be inflated upwards of 40 times over standard rates

Beyond those charges appearing as unfair and even predatory, is the expectation that such charges are illegal. Under Florida law, all vehicle owners are required to carry personal injury protection (PIP) insurance. Insureds are required to pay a 20 percent deductible based on the billed costs of service rendered. But those costs are also required, under PIP statutes in the state of Florida, to fall within “customary and reasonable” pricing guidelines.

Both patients wound up having to pay for part of the bill out-of-pocket after the ER fees for service exhausted the limits of their PIP coverage.

According to various pundits, a gambit observed by most hospitals is to overbill those patients with health insurance, and then enter into negotiations with the insurance provider that usually results in the fees for service rolled back to a more reasonable amount. In fact, most insurers have been described as expecting an overage, and will subsequently push the hospital to lower the final bill for fees as a matter of course, not unlike going into a car dealer and negotiating a “deal” that falls below the sticker price.

Everybody knows that you don’t pay full price for a car. Negotiation is a given.

Same goes for health care.

But what of the Americans without insurance, either by choice or by circumstance, with either limited or unlimited means to pay? How much are they overbilled? And do they attempt to negotiate the fee, or just pay it?

Chances are, any uninsured patient billed for emergency room service has been overcharged - often substantially. Thus, any uninsured patient who may have made payments in full or in part has likely paid a far higher fee than standard rates for those procedures.

It’s time to fight back

Beyond the unfairness, it may be illegal. A telling example of the potential illegality is where a hospital will push to force full payment of a bill, only to back off and forgive all or part of the bill if a patient threatens to sue, ostensibly to avoid litigation. This gets the patient off the financial hook to the hospital - but it also lets the hospital off the hook as well, in terms of unfairness and alleged illegalities associated with overbilling.

According to attorney Barry Kramer, hospitals that are currently under investigation for overbilling uninsured patients include Dignity Health, Daughters of Charity Health System, Prime Healthcare, Scripps Health, Anmed Health, Moses Cone Health System, Harborview Medical Center, Lehigh Valley Health Network, Lexington Medical Center, Mayo Clinic, Mission Hospital, Palmetto Health, Sharp Medical Center and Memorial Health.

Regardless of a hospital’s attempt to roll back a complete or partial overcharge in response to a litigation threat, it behooves a potential plaintiff who has been grossly overcharged to take the hospital to task over chronic overbilling. Faced with the potential for costly settlements and compensation stemming from emergency room overcharge lawsuits, hospitals may very well re-think their policy with regard to needless and predatory overbilling.

Perhaps they may even stop altogether.

There is little doubt that running a hospital remains a formidable challenge, and underfunding is chronic. However, grossly overcharging innocent Americans is both unfair and potentially illegal. And like the bully in the candy store who will continue to sneak free sweets when the proprietor isn’t looking until he’s caught, hospitals are expected to continue the practice of overbilling as long as they can get away with it.

At least, until someone fights back.

So fight back…

The Florida lawsuit is Herrera et al. v. JFK Medical Center Ltd. et al., Case No. 14-CA-008372, in the 13th Judicial Circuit Court of the State of Florida.