Medicare Fraud

I went to the wound center at Ohio Valley General Hospital for my foot. Last night, I got an email from my insurance company that there was a new EOB available. Let’s just say I was not too happy when I looked at it. Ohio Valley General Hospital put thru and was paid for a charge for “Operating Room Service.” I was NOT in the operating room. They did a debridement that my previous doctor was paid $135 for.  In fact at my visit on the 5th, the doctor discussed possibly taking me to the OR to open my foot up. They got paid $572.99 for the charge on the 5th that had no operating room involved.

Ohio Valley General Hospital Insurance Claim

I called my insurance company this morning and was basically told that they had to pay it how it was put thru – which is what I basically expected to hear. I then called the billing office at Ohio Valley General Hospital and I was told that I needed to call the wound center.

When I called the wound center, I asked to speak to the person that does the billing. The witch that was at the check out desk is the one that picked up the phone so I knew that call was going no where when she was the one that picked up. I was already on her fecal roster because I asked her to see what the doctor that wanted me to make a morning appointment wanted me to do when she was not able to give me an appointment for a time I could get there. My guess from my conversation with another employee there when I went back on the 15th, they have had complaints about her. I ended up canceling the appointment that I had for this coming Friday. After I hung up, I printed out their records request form and sent a letter requesting my records. I put this paragraph in that letter:

I understand that a wound center is a specialty place and should be paid higher rates. However, I have a problem with you billing Medicare as “operating room service” for a debridement. That amounts to nothing more than fraud in my book and I have had my fill of trying to get basic things I need to stay alive while people like you gauge the system. That is wrong.

I have been sitting here worried about being able to get Apidra insulin next year – that “operating room service” charge is three boxes of insulin (each box of Apidra pens gets paid at $187.24) that would last me about six months. I had a second visit to the wound center that was not billed yet, so that is one full year of Apidra that I could have had. Instead of getting the insulin I need to stay alive, I was an unwilling and unknowing participant in price gouging. And people wonder why Medicare is in trouble!

I was given the number for fraud complaints but my experience is that those numbers are useless. I am going to put my complaint in writing.

I know that I am risking losing my leg by not going back there but I am not going to participate in something that I know is just wrong. In the end, I am the one that has to stand in front of God and explain my actions. I make enough mistakes without trying very hard and I am not going to participate in what amounts to nothing more than fraud.

EDITED TO ADD:  Please see the article that I wrote, Wound Center Charges Explained.



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