I just discovered that my infusion company, who provides IVIG medication, supplies, and nursing, has sent in many fraudulent claims for visits and treatments not given! I'm freaked out about it.
I discovered:
12 nursing visits claimed and mostly paid for that weren't given for this February through the 2nd or 3rd week in May!
3 visits last year billed for and not given.
Medication worth thousands of dollars billed for last year that wasn't given.
3 treatments billed for this year that weren't given.
2 doses of meds that were expensive that weren't given.
Most of the charges were around $150, but then there were some for lots more, including the med for thousands of dollars. It's possible that that one was a mistake, as I was supposed to get it weekly, but didn't get it that week. But the rest is surely not a mistake. And even that one is hard to justify. There are records of everything that is given.
I have a very limited amount of nursing visits per year in my insurance plan. I've very carefully kept track of what is being used, and planned everything accordingly, which has been very complex.
And now I see they've billed for 12 extra visits this year already!!
And the hard part is, much as I want to walk away from them, I'm screwed if I do, due to the nursing visits billed, and due to the fact that it is incredibly hard now to get authorization for this treatment. I only got it this year, due to reporting the insurance company to my state AG's office (which probably won't work the next time).
So if I leave them, I'm back to square one with no authorization, no treatment, nothing. And very, very hard to get authorization again. But I'm fed up with this, and don't trust them now. This is the last thing I need right now.
I think the reason they did this is to try to get better reimbursement from the insurance company. But this is fraud! Insurance isn't free. And it puts me in a very, very difficult place. I should NOT be having to deal with this at all.
I'd love to leave them, if it didn't screw me up, which it would. I've really, really had it! I am having to fight so darned hard for every single thing, it's unreal. These providers think I'm a cash cow, which I am for them.
Posted by michele-lyme (Member # 35098) on :
Sometimes it's one bad apple and not the whole bunch.
I would start with their office first, to give them a chance to remedy the situation. How about discussing it with the office manager in a non-confrontational way?
Let her/him know you found discrepancies and that you're a bit concerned about trusting them to move forward, but since the treatment with them is working, you would like to continue and use the wrongly billed visits/meds as credits towards current service.
You might as well use it while you have it. Especially since it's so hard to get authorization or treatment, as you say.
That would give you time to look for someone else or other options. It's definitely too hard to start over especially with lyme and co's.
Now that they know you are watching they will pay better attention to your case.
Once you've used up your credits you can decide how to proceed with them aftewards. Especially if there are any other descrepancies from now til then.
Keep us posted so others will know what their options are in a situation like this.
Good luck. Posted by Rumigirl (Member # 15091) on :
Now I checked back on a previous infusion company's charges for IVIG treatment from January '11, and discovered that they put in claims for 4 days of treatment and meds that I never received, and got paid more than $8,000 for each of the 4 days, totaling well over $24,000 for treatment and meds not given!! OMG! And this was over a year ago. This is unreal.
Posted by michele-lyme (Member # 35098) on :
Wow. That's ridiculous. Imagine if they do that with every patient. Are they ripping off medicare by chance? Or private insurance?
Posted by Rumigirl (Member # 15091) on :
Private insurance. I am really upset. I'm going to report the one from January '11. But I doubt that anything will happen. I once reported a fraudulent claim that had been paid to my insurance company, and they did nothing, even though I called several times to urge them to do so.
The current one, I'm going to have to start by dealing with the company. Oh, joy---not!
Posted by MattH (Member # 30846) on :
Many states have a state medical board. You may be able to see on line how these things get reported.
I may have a similar issue but I really do not care to go back to the MD I am using so I think my issue will be easier to deal with.
All the Best, MattH
Posted by randibear (Member # 11290) on :
i went to one supposed LLMD many years ago. they charged my insurance for office visits that i never went to.
luckily bc did not pay them. the dr's office billed them repeatedly for almost a year for stuff.
they sent me letters telling me i owed them all this money. it was in the thousands!! i didn't pay them.
i called bc and told them i wasn't seeing him and they sent a letter telling them to stop and they didn't pay him.
i understand he had a lot of problems later with this type of thing and eventually stopped seeing people.
boy, was i po'd....
and for you i'd report them immediately. be prepared to have all paperwork and prove your claim. others may have this problem also but at least talk to them.
remember this is not only costing you but it's costing us also.
Posted by Rumigirl (Member # 15091) on :
One of the problems is that it would take until the end of October just to use up all the extra nursing visits billed for this year alone!! That's a long time to hang in there with this company under the circumstances. This is so screwed up, I can't believe it. I have a call out to the company from yesterday afternoon, saying it was important. No call back yet. Arghhh!
We are having to pay an extraordinary amount for everything for our insurance this year, due to high usage last year (even though it's through my husband's job). Everything is sky high---deductibles, co-pays, out of pocket costs. And this is partly why. On top of that, although it is supposed to cover my LLMD visits and tests, insurance will cover basically none of that, no matter how hard I fight.
This whole thing is one more reason that I would like to say, the heck with all the drs and treatments, and just go back to my rife machines, etc. But I did that for 3-3 1/2 years, and only got worse. Abx was the only thing that helped. But it's been an unreal obstacle course, with mostly nothing but obstacles.
It is so hard to keep fighting and try to keep up a hope of getting better. To add this to the mix??!! I'm not a saint. Or am I? If I am, there are lots of us here who are---which I think is true, actually.
Posted by poppy (Member # 5355) on :
If they don't call back soon, send 'em a registered or certified letter with all the details and ask what they plan to do about it, so you will know what further steps to take. Include that part that suggests you will be taking further steps if this is not resolved quickly.
Decide how you want them to handle this. Advice on how to handle complaints usually involves knowing what you want done about it, so it is not open-ended. It is specific. So, you might ask what they will do to correct this, and then make your suggestion.
It would be better to start out with the assumption that it was clerical error, not fraud (even if it was). That way your tone is less threatening.
And if it is fraud, this at least will put them on notice that patients do watch. More of them should.
Posted by Lymetoo (Member # 743) on :
Call them on it.
I know someone who says this goes on all the time. Especially with Medicare or Medicaid.
Posted by map1131 (Member # 2022) on :
Do the right thing! We all pay for fraud. Taxes, medical insurance rates.
Pam
Posted by Keebler (Member # 12673) on :
- First, be sure it's not some error on the part of one person who may have just made a mistake - or a series of mistakes.
Someone may be ill or just not paying attention but I hope you can start with the company itself, just in case there is a logical - and isolated - error.
I can't tell you the intensity of mistakes I made in some of my last jobs - all because I just could not think straight due to illness.
Beyond that, of course, talk to the department who oversees them, to be sure they are held to honest standards and their books can be reviewed.
But this may not be a huge intentional operation. Hope not. If you sense it is after you've made some inquiries, of course, keep going up the chain of command, outside of and independent of their company.
I do suppose, though, that you would have to report it to outside authorities in case they could claim it was just isolated but that not be true. -
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