Katers & Granitz Investigating Illegal Balance Billing Practices by Healthcare Providers
Most Americans enjoy great healthcare. Our trauma centers and EMS programs are world class. That’s because of the efforts of millions of dedicated nurses, EMTs, paramedics physicians and technicians. They certainly deserve our respect. Unfortunately, the people who employ them sometimes get a bit too greedy.
At some point in life, many of us will need emergency medical care. If you are suffering from a stroke and unable to communicate, you certainly don’t have much say in who transports you to the hospital or to which hospital you go.
A few unscrupulous healthcare providers have figured that out and are trying to gouge patients in their hour of need. In every state, such behavior is immoral. In some states it is also illegal.
We are investigating claims that some companies are illegally billing Medicare patients for the balance of bills after Medicare has already paid. Those practices may also be illegal in approximately 21 states. The states with some of the strongest balance billing protections states include California, Connecticut, Maryland, Illinois, Florida, and New York.
Healthcare billing is complex. A hospital or ambulance service may have rates set by the state or may have negotiated dozens of different reimbursement rates with private insurers. Under federal law, however, if the provider accepts Medicare, it should not try to collect anything other than a small co-pay.
Recently we wrote about billing by air ambulance companies. Some folks get billed $50,000 for a five minute ride. And most of that is not reimbursable by insurance.
After we posted our air EMS story we were asked by a reader to investigate ground ambulance service and hospital Emergency Room billing. That makes sense since so many more people are treated in ER’s and transported by traditional ambulances.
We were shocked by what we found.
A recent Bloomberg article discussed a Seattle man who received a $1056 bill from American Medical Response (AMR). The bill was for a five mile ambulance ride taken by his late wife. She died shortly after the transport. Medicare paid $276 for the ride but two years later AMR started billing the man for the balance. Because she was insured by Medicare, we believe those collection attempts are illegal.
Balance Billing and Medicare
The practice of chasing patients after first collecting from insurance companies is known as balance billing. Depending on the state, the practice may be illegal. If Medicare is the primary insurance, balance billing probably is illegal.
Medicare, California, Maryland, Connecticut New York, Florida, and Illinois have comprehensive restrictions on balance billing. Fifteen other states have some restrictions: Colorado, Delaware, Indiana, Iowa, Massachusetts, Mississippi, New Hampshire, New Jersey, New Mexico, North Carolina, Pennsylvania, Rhode Island, Texas, Vermont and West Virginia all have some restrictions.
These regulations don’t stop the practice. In some states, state law restrictions are pre-empted by the federal ERISA law. Because there are so many loopholes, the bad healthcare companies think they know how to push the limits without getting caught.
And who is the main culprit? We are focusing on Envision Healthcare, its subsidiary EmCare and American Medical Response (AMR). Those are the ones we know about but there are probably hundreds of copycat schemes out there. That means many other bad actors.
[Until recently, Envision owned American Medical Response. In March, AMR was acquired by KKR, a private equity company. Now KKR plans on purchasing the rest of Envision.]
Envision Healthcare and EmCare
Envision Healthcare is quietly gaining a foothold in many hospitals. It does so through its staffing subsidiary called EmCare.
Patients needing treatment will often go to a hospital identified as a network provider. It is common for insurance companies to have contracts with some hospitals but not others. That doesn’t stop the patient from going to a hospital of their choice. If the hospital is out-of-network, however, they might get socked with a huge bill.
According to a recent New York Times article, when EmCare takes over a hospital’s emergency room, it doesn’t always agree to the pre-negotiated rates and fee schedules worked out between the hospital and the insurance companies.
Patients think they are going to an in-network hospital only to be shocked when they start receiving huge bills from EmCare. Several states – including California and New York – have legislation to stop these “surprise bills.” They are surprised because even though the hospital is in network, the ER doctors are not.
Washington state tried to pass surprise billing legislation earlier this year but it was defeated by lobbyists.
We hear that not only does EmCare not honor existing agreements with insurance companies, they also jack up their rates. Dramatically.
The New York Times looked at the ER physician rates charged at Newport Hospital and Health Services, a rural Washington state hospital. Rates jumped from $469 to $1649. That is the difference between what the hospital’s ER doctors charged versus what was charged for those same services once EmCare took over. Considering little may be covered by insurance, that can result in a huge surprise or balance bill.
Healthcare insurance giant United Healthcare has become so incensed over these surprise billing practices that they put up a website directly attacking Envision’s billing practices.
It’s not just patients and insurance companies that are angry. EmCare and Envision Healthcare last year paid the federal government $31 million to settle charges that EmCare was maximizing profits by admitting patients to hospitals even if those admissions were not medically necessary.
Now the company is facing class action lawsuits in several states.
Seeking Patients Who Received Balance Bills or Surprise Bills for EMS, ER Services Out-of-Network
Envision and EmCare have already been tagged by the federal government for their billing and treatment practices. They are facing lawsuits in several states as well.
Despite the existing suits, we wish to speak with patients of Envision Healthcare or EmCare that received collection attempts on the balance of their bills after Medicare had paid for the service. We are also looking for people with private insurance. If you received an unexpected balance billing, please contact us.
Our investigation also includes AMR and any other healthcare provider engaged in surprise or balance billing.
As noted, there are several class action lawsuits pending. With so many different laws and states, however, we know that there are probably cases yet to be discovered against these companies.
Please remember, our investigation includes any companies engaged in illegal balance billing or surprise billing.
In our years of experience, once one fraudster has figured out a vulnerability in the system, so have others. This scheme is particularly onerous because it prays on people who are often in critical condition and have no say in their care.
Why a Class Action?
Suing a huge healthcare company is a David vs. Goliath battle. The battle can be won but it is expensive and hard to do alone. In a class action case, the court allows the case to be filed on behalf of all patients with similar claims.
Let’s be blunt. It just isn’t cost effective for 99.9% of patients to sue on their own. In a class action, you have the clout of hundreds or thousands of other patients and there is no requirement to advance fees or costs. As class action lawyers, we don’t get paid unless we first collect money on behalf of the class.
If you are a patient and need more information or want to help us with our investigation – there is no obligation or charge for a consultation – contact us online or by email at [hidden email].
Seeking Envision, EmCare, AMR and Other Whistleblowers
Unlike other class action firms, we are also a whistleblower law firm. The best way of exposing fraud and helping taxpayers and patients is with the help of an insider. And in some cases, we can help that insider collect a large reward for stepping forward.
We are looking for healthcare professionals with any inside knowledge about surprise billing or balance billing. Even if you are not sure if the process is legal in your state, we are happy to do that research free of charge.
Very often unscrupulous businesses will tell workers that the company’s actions are legal. What else can the say? But simply because HR or the billing department says the healthcare provider’s billing practices are legal doesn’t make that so.
As whistleblower lawyers, our mission is to help you collect the maximum reward possible, fight fraud and put an end to the illegal behavior. Like those signs on public transportation and airports say, “If you see something, say something.”
Need more information? Visit our healthcare whistleblower page. If you think you may qualify or wish to help, contact us online, by email [hidden email] or by phone 800.669.7782. (We apologize in advance, we can only take calls from healthcare providers seeking to be whistleblowers. All other inquiries should be online or by email - see the links above.)