Saturday, October 29, 2005

Graft in the medical /insurance industry is in serious need of investigation.

One of the primary reasons for high medical costs is all the corruption in the medical industry.

When you go to a medical facility and you are asked to pay upfront, be cautious. It is better to sign a finacial agreement that you will pay x amount of dollars except for copays.

I have recently interviewed an individual who works for MRI Management LLC, a billing office for Open MRI's (Magnetic Resonance Imaging) in Georgia, Florida' and Arkansas who are ripping insurance companies and patients off.

They will take an upfront payment and when the insurance pays, if there is an overpayment between the two and there is a credit balance owed they are not calling to tell nor allowing staff to notify the patient or insurance company of a refund.

Also, if an insurance company overpays they do not automatically refund the insurance company per the "Dr./ owner" who will not authorize it. My confident quotes management, "Do not process any refunds unless requested by the patient". Hmmmm, I wonder....sounds like the "Dr" is definitely not following the law . Insurance laws state that "if a patient or insurance company is due a refund" then these accounts should be worked and any monies found overpaid refunded. According to my snitch the MRI's Management LLC will keep the patient's and the insurance companies overpayment.

In just the small center my informant works, there has so far been an average of $1700.00 a week in credits owed. This would add up to $88,400.00 a year. For the three larger centers in Macon, Ga, Suncoast and Tallahassee,FL that would be a credit balance of $2500.00 a week with a yearly toal of $130,000.00 for each center. So, for the small centers that would be a yearly total of refunds illegally kept in the amount of $530,000.00 and for the larger centers $390,000.00. The total for all centers is $920,000.00. A tidy little sum I say. These discoveries were made in the 3 months that the individual has worked for this corp. and If this policy has been ongoing for the 5 years I hear this place has been open that would make an estimated 3.5 to 4.5 million in monies illegally pocketed.

Again my suggestion for patients is not to pay anything up front, make them tell you how much you will owe and sign a financial agreement so they can only charge the amount owed after insurance pays. It has always been a standard with me that when I go for any type of radiology I never pay anything up front, or for that matter any medical services.

Tell them to bill you.

As for this particular business. Their day will come.

Nuff said