I had surgery in a private surgery center. I found out that they billed my insurance company $139,000 for an outpatient procedure (wtf???!! absurd amount). They then threatened me by email that I may be liable for the amount if I don't okay the the charges to the insurance company. I'd like to report the activity to someone who investigates this stuff, or talk to a lawyer. It's in San Jose, CA. Any ideas?
The reason I want to report is that I think this is fraud and it costs taxpayers and consumers money, and creates bad incentives in healthcare.
Alternately to reporting, I might consider suing the surgical center if my doctor is a partial owner, because if so, there is a huge conflict of interest in him referring me for surgery if he is making an exorbitant amount of money on my procedure (and not disclosing his incentives). I imagine I am not the only patient in this boat.
On the other hand, I am grateful to my doctor for the work he did on me, and he's a fantastic doctor. He is not just a fantastic doctor. He's an extraordinary doctor who took away my pain two years ago (this is my 2nd surgery with him). I am not even sure he is aware of this billing practice.
I'm conflicted, because I think this sort of practice is highly unethical. My surgery was not an $140,000 surgery, and it's patients who bear the burden of fraud (in higher insurance premiums and maybe even unsafe pressure to have expensive surgeries). I am troubled because I think I am seeing fraud, but I don't know what to do about it.
I found an article about other surgery centers doing this.
This is my second surgery with the doctor. Two years ago I had surgery and he did it at a large public hospital, and this year he was at this private clinic and I got news of these crazy charges.