Is it illegal to send a fraudulent billing statement?

[Dangerosa]

I never get credited back for my co-pays at the clinic - and it isn’t worth the $15 for me to argue over it.

I do get credited back when I overpay my dentist…both my dentist and the pediatric dentist are really good at keeping their books and very prompt about returning overpayments.

[emacknight]

@t-bonham@scc.net

For non-profit organizations that I’m Treasurer, I get fakes all the time:

• from phone companies, for a Yellow Pages ad in some book I’ve never heard of. (Fine print somewhere on the ‘bill’ will say “this is not a bill, but solicitation for you to buy an ad” in their directory…)
• from internet companies, billing for our websites. (Fine print somewhere on the ‘bill’ will say “this is not a bill, but solicitation for you to switch to them as your registrar”.)
• from office supply companies, for supplies (usually paper). (Fine print somewhere on the ‘bill’ will say “this is not a bill, but solicitation for you to order paper from them”.)
• from long distance companies. (Fine print somewhere on the ‘bill’ will say “this is not a bill, but solicitation for you to switch to them for your long distance billing”.)

Apparently this is not illegal – it happens all the time. Some of them are really legitimate-looking fakes. I have had such ‘bills’ sent to me by an employee with a note to “please pay this quickly”.

I do appreciate what you’re saying. The difference though between your scenario and mine is that on yours the asterisks says “this is not a bills.” On mine it said, “this is a bill that you must pay, and your insurance company said it won’t pay.”

BTW: I could use $15, mind sending me a check once a month? Would it help if I sent you a fraudulent bill?

[msmith537]

If they are sending you a bill after payment has already been posted to their system and they don’t reimburse you if you double pay (or at least indicate so on your account statement), then it is clearly a case of fraud.

[kaylasdad99]

@Frank

I paid a bill from the doctor for my rotator cuff diagnosis for my co-pay of $100. A few weeks later, I received a notice from my insurance company that their deal with the doctor meant that the charge for my visit was the “usual and normal rate” of $72, and since that was under my co-pay, that’s what I owed to the doctor.

I’ll give you exactly one guess as to whether I have ever seen that $28 again.

Did you ask for it?

[Dangerosa]

@msmith537

If they are sending you a bill after payment has already been posted to their system and they don’t reimburse you if you double pay (or at least indicate so on your account statement), then it is clearly a case of fraud.

Fraud implies intentional. I’m not certain that all medical practices that double bill are doing so intentionally. They tend to have really screwed up books. Insurance filings make the accounting very complex. Doctors often hire bookkeepers to keep their accounting and insurance straight - instead of treating accounting like a complex profession. One of my Accounting Profs made a pretty good living just auditing and cleaning up medical practices, so he’d talk about it a lot. He didn’t think it was fraud - or even willful ignorance - as much as just a lack of understand how complex running a practice is from an accounting standpoint.

That said, I’m pretty sure that some practices do engage in fradulent double billing.

[Sailboat]

@Dangerosa

That said, I’m pretty sure that some practices do engage in fradulent double billing.

I’ve definitely encountered it. I’ve received bills that in the fine print say I do not owe anything, but in the large print insist I send them the money now. I’ve called and asked about the charges and been told they are moot (paid already by insurance) and then received the exact same bill, over and over, for months – always hoping I’ll forget or panic and send them free money.

It’s just about as bad as a Mafia enforcer suggesting something bad will happen to my kneecaps unless I pay up, and then coming back frequently to demand more money.

[emacknight]

@Dangerosa

Fraud implies intentional. I’m not certain that all medical practices that double bill are doing so intentionally. They tend to have really screwed up books. Insurance filings make the accounting very complex. Doctors often hire bookkeepers to keep their accounting and insurance straight - instead of treating accounting like a complex profession. One of my Accounting Profs made a pretty good living just auditing and cleaning up medical practices, so he’d talk about it a lot. He didn’t think it was fraud - or even willful ignorance - as much as just a lack of understand how complex running a practice is from an accounting standpoint.

That said, I’m pretty sure that some practices do engage in fradulent double billing.

Yes, I can definitely see this occurring at smaller, private offices, just as it happens with any small business, and am sympathetic to the complexity involved. I have an friend working with a dentist office cleaning up their processes.

But there are two problems: 1. how long should we reasonably tolerate that sort of incompetence (1 year, 5 years)?

2. The two clinics that are sending these bills are huge. They each have a massive billing and accounts department. This isn’t a new or infrequent issue for them. Some one, at some point, decided to implement this billing process, and that person at some point had to know this is what was going on. Which is where I get frustrated. It’s not as if they are dealing with insurance infrequently, or that my insurance company is weird and unknown to them.

And that’s why I think it’s fraudulent behaviour. They know they are billing insurance, they know it takes a certain amount of time to receive the payment. But they still insist on sending me a bill, emphasizing that insurance has not paid.

Do you suppose they are also sending multiple bills to my insurance company? Or would that ACTUALLY count as fraud? I can’t imagine BCBS would tolerate receiving multiple requests for a co-pay that was already paid by the patient.

[Frank]

@kaylasdad99

Did you ask for it?

Yes, I did, in writing, with a copy of the statement from my insurance company. That was all $28 was worth of my time. I did not pursue it any further.

Now I know something about St. John’s that I didn’t know before, and that will factor into my future decisions about health care.