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by wyldfire 2371 days ago
No way, this was totally deliberate fraud. The physician likely included all of the accompanying diagnostic codes for ultra rare/serious symptoms/history so it wouldn't get rejected by the insurer. Plus when asked for an explanation by the reporter they didn't opt to fessing up to a mistake or explain why the charge was necessary: they offered no comment whatsoever.

Their fraud relies on insured patients not reading EOBs (because many of us don't).

1 comments

Fraud on the part of the practice, yes possible.

The parent comment seems to imply the payer is at fault or committing fraud.

I thought it was obvious so I didn't spell it out, but yes this is the practice defrauding the insurer.