So, the point they're making on 3 is that hospitals and docs are incentivized to bill for as much as they can (needed or not), with the expectation that some of it won't make it through the bean counters back-and-forth with the insurance company. Conversely, docs who prescribe only the necessary care can expect to still have claims denied because of the overall abuse of the system. That's what they mean.
If anyone is interested, go read the O'Reily book "Hacking Healthcare" to learn about how brainfucked the system is.
That makes sense, but again the ACA has provisions with massive fines ($50k+ per instance) for overbilling and a well-funded team of auditors to look for transgressions.
If anyone is interested, go read the O'Reily book
"Hacking Healthcare" to learn about how brainfucked
the system is.
Thanks for the rec, it's been in my Kindle queue for awhile now, I'll make a point to actually read it soon.
No problem; $80,000 per spinal fusion.
Even if caught, they're profiting. If.
Cute, but the actual text in the law provides for penalties of either $50k or 3x the cost of the overbilled procedure. It also has provisions to bar them from ever submitting another claim to a Federal agency. So criminally overbilling for $80k could cost you $240k and your ability to practice medicine.
If anyone is interested, go read the O'Reily book "Hacking Healthcare" to learn about how brainfucked the system is.