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Edward Johnson
Edward Johnson, U.S. Army Medic
Category: Health
Satisfied Customers: 10760
Experience:  U.S. Army Medical Services Corps, and Special Forces Med School, Ft. Sam Houstan, Tx; EMT U.AK
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Can you recommend a lawyer to counsel me on handling a hospital

Resolved Question:

Can you recommend a lawyer to counsel me on handling a hospital charging me outrageous prices for services (of questionable necessity and most of which I never requested) related to a hospital stay?
Submitted: 5 years ago.
Category: Health
Expert:  Edward Johnson replied 5 years ago.

Dear garrand,

 

For legal reasons, I am unable to provide a personal referrel.

 

However if you tell me your state and county, I can make some general recommendations.

 

 

Customer: replied 5 years ago.
State - Chicago
Country - USA
Expert:  Edward Johnson replied 5 years ago.

Garrand,

 

I apologize, I meant county not country. But that is not necessary, I am aware of Chicago's county.

 

The following two law firms were recommended by the Illinois bar association as having a history of success with health care fraud.

 

http://www.chicago-lawoffice.net/PracticeAreas/Health-Care-Fraud.asp

 

http://www.robertloeb.com/chicago-fraud.jsp

 

Loeb is the better known.

 

You can also seek a personal referrel from the bar association attorney referrel tool:

 

http://www.chicagobar.org/AM/Template.cfm?Section=Need_a_Lawyer

 

 

Before you call the attorneys, let me give you some information you may need.

 

While the hospitals and clinics and some physicians do charge seemingly outrageous fees. They can generally charge what ever the market will bear.

 

If your medical care includes medicare and insurance claims, out of network, then you are perty much open to what ever they charge.

 

If the claims are in network with Medicare and the INsurance company they are held to regulated prices, called customary and reasonable. http://edocket.access.gpo.gov/cfr_2005/octqtr/pdf/42cfr413.13.pdf

 

Reasonable and customary charges are linked to diagnostic codes called CPT and ICD9 codes. These are numeric codes that are defined by CPT and ICD9 manuals for procedures and doctor visits, and vary by length of visit, procedure, complicity of the procedure and or visit, etc.

 

In most instances (I am going to say more than 90%) of health and medical care fraud, not mal practice, the source is coding errors or coding fraud.

 

For example, you were seen for a 10 minute followup appointment, but the doctor coded it as a 45 minute complicated problem, in order to bill more. (higher customary and reasonable).

 

Or a podiatrist may trim toenails on their diabetic patient, and code it as a surgical procedure. (it can be, but most are not).

 

The control is to have the medical records audited.

 

The doctor's notes have to support the diagnosis, length and complicity of the visit.

 

It is not necessarfily fraudulent to charge you a high price unless it is connected to coding errors or violations; or unless it is a Medicare related fraud in terms of what they are supposed to charge in network.

 

You can file a complaint with the HHS and your insurance company if you believe they are out of line with any of these issues.

 

 

 

Edward Johnson, U.S. Army Medic
Category: Health
Satisfied Customers: 10760
Experience: U.S. Army Medical Services Corps, and Special Forces Med School, Ft. Sam Houstan, Tx; EMT U.AK
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