By Bill Hennessey, M.D. – The Doctor of Healthcare Cost Savings – Visit my website
WVU Hospital Commits Fraud by Using Revenue Codes to Unbundle and Financially Extort Its Community
1. Revenue codes are NOT medical billing codes. Revenue codes are owned by Centers for Medicaid and Medicare Services (CMS).
2. Note the orthopedic surgeon properly has used billing codes, known as 5 digit CPT codes. CPT codes are owned by the American Medical Association (AMA).
3. So why did WVU Hospital use revenue codes and not CPT codes? Answer: to financially unbundle care to charge a multiple of what it is really worth.
4. Use of revenue codes for outpatient care billing is fraud.
5. Unbundling of CPT codes via several revenue codes is fraud.
6. Charging a multiple of what the care is worth because someone needs care is a contract of adhesion which is illegal.
7. Patient does not need ligament surgery yet the estimate includes it. More fraud.
8. WVU Hospital provided a patient an “estimate.” No need for an “estimate.” It should be the actual fee for service. This is not the first knee scope at WVU Hospital and it’s a fixed amount of time, a fixed amount of effort, a fixed amount of square footage, a fixed amount of equipment. This warrants a fixed and real price tag.
This kind of patient abuse does not happen to Health Freedom members. healthfreedomus.com
