[Plura-list] Doc resigns after his employer charges $11k for a $8 covid test

Cory Doctorow doctorow at craphound.com
Sun Sep 6 12:17:17 EDT 2020

Today's links

* Doc resigns after his employer charges $11k for a $8 covid test: But
he still opposes medicare for all.

* This day in history: 2019

* Colophon: Recent publications, upcoming appearances, current writing
projects, current reading


🗻 Doc resigns after his employer charges $11k for a $8 covid test

Zachary Sussman is a pathologist who oversaw covid tests at 4 standalone
ERs for Physicians Premier, but he resigned in horror after he got a $8
covid test at one of the company's locations and then they billed his
insurer $10,984.16 for it.


In an outstanding investigation for Propublica and the Texas Tribune,
Marshall Allen reveals how both Physicians Premier and Unitedhealthcare
- the nation's largest insurer - feed into this system of fraudulent
price-gouging through a combination of greed and indifference.

There are elements of this that are just straight-up fraud: the coding
on Sussman's bill includes charges for procedures that simply were not
performed, like an antibody test, an in-depth investigation, a
problem-focused history, a nasal swab, etc.

To make the fraud even more ghastly, Physicians Premier (and USA
Emergency Centers, who license the name) overbilled for these procedures
that were never performed: they charged $3200 for the nonextistent
antibody test that they list at $75.

The vast majority ($8,884.16) came in the form of a "facility fee," a
major source of emergency care grift that crops up whenever private
equity funds get involved in emergency care.

When you hear about someone getting thousands in out-of-network fees for
an icepack, that's almost always a "facility fee."


In this case, the fraud and facility fee were compounded by the fact
that Physicians Premier/USA Emergency operate "standalone ERs" that are
100% out-of-network, meaning that they bill crazy sums that are either
negotiated down by insurers or passed along to patients.

The final component of this incredible fraud comes from
Unitedhealthcare, the largest insurer in the country. They have been
gouging like crazy during the pandemic, racking up $6.6B in earnings in
Q2-2020 alone. This has drawn a ton of scrutiny and criticism, naturally.

Which may explain why the company simply greenlit this obviously
fraudulent charge (and why their internal fraud investigators were
totally blase when Sussman called them up).

They're making incredible, towering sums profiteering off the pandemic
and sending it to shareholders and execs, rather than upgrading their
creaking anti-fraud systems. They don't want to call attention to any of
this and mess up their good thing.

The CARES Act mandates insurers to pay for (many) covid tests, and the
grossly inefficient, wildly profitable health-care system has used this
as an excuse to gouge the grossly inefficient, wildly profitable
insurance sector.

Nobody (except plutes from the shareholder class) wins when these two
giants wrestle one another.

The lesson of this awful scandal is that a broken, for-profit
health-care system can't be fixed by mandating care.

Without a publicly accountable, public-spirited health care system, the
CARES Act's mandate to pay for testing was just an invitation for the
grossly unethical for-profit care system to gouge insurers.

The exception to this is Medicare, which caps pricing for antibody tests
at $42.13. Ironically, Sussman told Propublica he only came forward
because he opposes Medicare for All and fears that abuses will give the
existing system a bad name.

"If instances like these go unchecked it will provide more ammo for
advocates of a single-payer system."

Physicians Premier Austin


🗻 This day in history

#10yrsago Gibson's ZERO HISTORY: exciting adventure that wakes you to
the present-day's futurism

#10yrsago Latest leaked draft of secret copyright treaty: US trying to
cram DRM rules down the world's throats

#1yrago Regular expression crossword puzzles! https://regexcrossword.com/

#1yrago 10 bipartisan Attorneys General launch antitrust investigation
against Facebook

#1yrago Robert Bork is the architect of the inequality crisis

#1yrago Gaming's #MeToo moment: male fragility versus women's
fundamental rights

#1yrago University of Kansas's Campbell Conference changes its name to
the Gunn Center Conference

#1yrago Australia wants to kill consent requirement in proposed
data-sharing legislation, calls it "nuance"

#1yrago Information security and warfare metaphors: a toxic mix made in

#1yrago Amazon's plan for traffic deaths from same-day delivery: deflect
blame to anonymous subcontractors

#1yrago Gallery of Hong Kong protest art: #BeWater


🗻 Colophon

Today's top sources: Naked Capitalism (https://www.nakedcapitalism.com/).

Currently writing: My next novel, "The Lost Cause," a post-GND novel
about truth and reconciliation. Friday's progress: 520 words (57818 total).

Currently reading: Gideon the Ninth, Tamsyn Muir

Latest podcast: Someone Comes to Town, Someone Leaves Town (part 14)

Upcoming appearances:

* Keynote for Law Via the Internet conference, Sept 22,

* Writing into an Uncertain Future, Afterwords Festival, Oct 1,

Latest book:

* "Little Brother/Homeland": A reissue omnibus edition with a new
introduction by Edward Snowden:
https://us.macmillan.com/books/9781250774583; personalized/signed copies

* "Poesy the Monster Slayer" a picture book about monsters, bedtime,
gender, and kicking ass. Order here:
https://us.macmillan.com/books/9781626723627. Get a personalized, signed
copy here:

Upcoming books:

* "Attack Surface": The third Little Brother book, Oct 20, 2020.

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*When life gives you SARS, you make sarsaparilla* -Joey "Accordion Guy"

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