Doctors use ‘innovative’ coding to slip high-priced services into patient bills

Dr. Ian Malcolm, the gibbering mathematician played by Jeff Goldblum in the 1993 film “Jurassic Park,” is arguably best known for his oft-quoted line: “Life finds a way.” The line, uttered ominously to the team of geneticists who have successfully cloned dinosaurs for use in an amusement park, is a personification intended to suggest that nature will override any attempts by presumptuous human beings to control her. That is, nature will get what she wants no matter what measures are affected to slow her down.

Nature, it seems, has a lot in common with profit-based health care. As Elisabeth Rosenthal (SHS 1974) wrote yesterday in the New York Times, many doctors, when faced with increased regulation limiting the ways patients can be billed for services, get shamelessly creative in keeping revenue streams flowing.

Take, for example, the practice of “surprise charges” on hospital and doctor bills. As various health care reforms take effect, and in anticipation of others scheduled to be implemented, many insurers have slashed reimbursement for many medical services. To combat this and the consequences such measures have for their pay scales, many doctors are using the expertise of out-of-network providers during surgical procedures, as well as over the course of other forms of medical care, without patient consent. The practice is usually justified to patients and insurers as medically necessary. The reality is that, often, the job such an out-of-network provider is called in to perform is one that could be performed by a nurse or resident at no additional charge.


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