- May 4, 2024
- Posted by: legaleseblogger
- Category: Related News
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### The Situation at the Doctor’s Office
So, I recently went to my doctor for my annual exam and asked for a pap smear, along with a comprehensive check on my blood for hormones and overall health indicators. Following the pap smear, my doctor recommended a cancer screening test from the company Grail. Upon inquiring about insurance coverage, I was informed that I could opt to make monthly payments for the test if insurance did not cover it. However, I expressed my reluctance to proceed with the test if insurance did not provide coverage.
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### Miscommunication and Billing Woes
Despite my explicit refusal to undergo the test without insurance coverage, the lab assistant proceeded with the test, citing misinformation from the doctor. Subsequently, I received an unexpected bill of $900 from Grail for the cancer screening test, which I had not consented to in the first place. Despite my efforts to rectify the situation by contacting various parties involved, including the doctor, the lab technicians, and the representative from Grail, I was met with indifference and a refusal to address the issue.
### Seeking Resolution
Feeling deceived and burdened by an unjust financial obligation, I am contemplating seeking redress through a small claims court. However, uncertainty looms over the viability of my case and the likelihood of holding the doctor accountable for the unauthorized test and ensuing expenses. The lack of clarity and conflicting accounts from the doctor and the representative from Grail have left me in a dilemma.
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****** just grabbed a
NAL. I’m a pharmacy technician who takes a required fraud, waste and abuse module every year.
Report this to your insurance company.
Report this to Medicare. I believe this falls under waste. Even if you don’t have Medicare, they might be interested in the fact that a doctor that sees ~~Medicare~~ patients is performing tests without the patient’s consent. If she’s performing unauthorized tests on you, it’s **very** likely ~~she is doing this test without Medicare patients’ consent as well~~ this is happening to Medicare patients as well.
Per the CMS (center for Medicare and Medicaid Services) website, you can call the Health & Human Services Office of the Inspector General
1-800-HHS-TIPS
Here is an explanation of fraud, waste and abuse. The anti kickback statute is explained ~~in~~ on page 9.
https://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNProducts/Downloads/Fraud-Abuse-MLN4649244.pdf
Also, report your doctor to the medical board for your state. Just Google your state medical board for their phone number.
I’m not sure what will come of this but it’s worth reporting. Your doctor did an unauthorized test after you repeatedly told her you didn’t want her to.
Edit: I added a sentence.
If you are in the US, the doctor potentially broke an anti-kickback law as laid out by the Department of Health and Human Services:
https://oig.hhs.gov/compliance/physician-education/fraud-abuse-laws/
Please contact your local health department to see what their reporting mechanisms are
NAL, but I do work for an insurance company. You can also see about filing a complaint about the doctor with your insurance, and if the test was billed to your insurance and denied I would also suggest filing a grievance essentially stating all of this information. Even if it wasn’t billed, you can try submitting for a reimbursement (depending on your policy) and when/if that is denied (or even if it only pays at insurance rates), file a grievance on that as well. It won’t make the doctor responsible for the costs, but could potentially remove your responsibility.
I am a physician and I would report this physician to their medical board. Pretty sure getting kickbacks/commissions for tests ordered is against the law and completely unethical. I would also report it to your insurance because they have a contract with your physician. When you report it, ask to file a “formal grievance” or “formal complaint.” This is so far beyond the pale.
Not a lawyer but I do work in healthcare. Contact your health insurance for the bill discrepancy then the OIG office of inspector general. This is fraudulent billing, not acceptable.
NAL, but I am a doctor. It is illegal for your doctor to get a commission or have any financial interest in a lab that she refers patients to. Report this to the state board. As far as the cost, often the lab themselves will check with your insurance company before running the test and let you know what your portion of the payment would be and the lab would be the one getting your consent. Usually they do this to avoid having someone refuse to pay this surprise bill. Ask the lab to prove you consented to the test.
I would also (strongly) suggest getting a different doctor.
It is important you dispute the bill *in writing* with the billing entity. Say you did not consent and the doctors office fraudulently requested the work on your behalf.
You can call your State Attorney General Consumer Fraud division. They will be able to assist you and get your case to the appropriate divisions of state government. You should also call your insurance carrier and ask them for help. But you may end up owing the bill. Sorry
NAL. AFAIK, no insurance companies cover the GRAIL cancer screening test. It is a cash only test and the doctor’s office should know this too.
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I work for program integrity for the government in fraud, waste, and abuse.
Contact your insurance company and report this as fraud first.
Depending on what type of insurance you have their are other steps.
Medicaid and Medicare have websites to report fraud.
You can contact the medical board online in your state if in the USA and also report the doctor for kickback schemes. You can do this online.
If you are in the US: Do not pay this bill. Advise the company that you are pursuing a complaint against the doctor regarding violation of the anti-kickback statute. Read about that here https://oig.hhs.gov/compliance/physician-education/fraud-abuse-laws/
Report the abuse and contact a lawyer.
File a grievance with the testing company and get a record/complaint number to open a case
well one things for sure, that cancer screener came back clean
Federal law, No Surprises Act: https://www.cms.gov/nosurprises
You are entitled to two levels of appeals of a coverage denial through your insurance company. The first is internal (often denied). The second is external. Although you blame your doctor, it’s worth exhausting the appeal process. Explain at each level that you were tricked into receiving it. Either the doctor or the manufacturer are capable also of writing this off. I would badger both with that request, and the appeal process will put further pressure on the doctor.
Ask for a copy of the form you signed as well as reporting your doctor. If you didn’t sign the form you have more of a leg to stand on.
I had something similar happen to me. I let it go all the way to collections after they sold the debt. I settled a $1k with $25.
NAL. I am however a medical laboratiry technician. And in my job we have similar forms, called ABN forms. There are multiple options on the form, including one that states you do not want the test. I always tell patients to read the options before signing it. Not sure if this is the same or a similar form, but if you checked the “yes, i want the test and understand i will pay for it out of pocket, regardless of my insurance” box instead of the “I only want the test if my insurance covers it” box or the “i do not want the test” box, you may have a hard row to hoe here. Sorry if that is not the answer you wanted to hear, but your post made it seem like you were told twice you would need to pay out of pocket, and you gave your consent to have the test performed anyways.
OH HELL NO. Do not pay one penny of this bill. Also contact your US Senator and US Congressional Representative. Go to their official .gov website and request assistance. Your tax dollars also pay for your Senators and Congressmen’s staff to assist their constituents with all sorts of matters. Having a Senators office reach out to your physicians office to help clarify federal standards regarding kick backs can make ALL SORTS OF THINGS SUDDENLY STRAIGHTEN UP AND FLY RIGHT. And, if you are 55 or older, this can also fall under elder abuse. Yep, you go get them gal! The audacity!
So they definitely broke some of the medical fraud laws, but u should know yourself it is fraud simply because they acknowledged that you didn’t want the test and you signed under the pretense the test wasn’t on the form. People have to read contracts, but the other party can’t lie about the contents or meaning of the contract.
U just need to properly report the fraud, and with this proper reporting, you can collect compensation for various things that did or can happen. For example, a company can mishandle that debt and damage your credit.
On top of doing what everyone here has said, report the doctor and contact relevant boards, you should call her office and request a copy of all the paperwork you signed
Report to the medical board
Pretty sure this is about to happen to me with GeneSight, so I’m glad I saw the post. I was never notified/asked by them, was told I’d get a call. Just saw a claim with my insurance that was denied. 🤦🏻♀️ thank you for asking this and I hope it gets squared away soon!
I can’t give you advice on your situation but I implore you if you feel you are not in the wrong to pursue this as far as you can within reason. My first doctor out of college did something similar to this a couple of times to me and I always just accepted it must be my fault because he’s a doctor and he knows what he doing But in the end he ended covering up two deaths related to a drug he was getting a payments to help trial with his patients – I’ll always wonder way back in my mind if I complained more if something would have happened sooner and he wouldn’t have been in the position to be involved in covering up those deaths. Every avalanche starts with one snowflake.
NAL but a healthcare worker, this a violation of your informed consent and like others have mentioned fraud or waste.
On the informed consent aspect, in addition to other channels it wouldn’t be a bad idea to explore making a report to the medical board in your jurisdiction.
This is a violation of the anti kickback laws. Companies cannot specifically give doctors commission. Report her to the medical board and report the company to the FTC.
https://abc7news.com/amp/cancer-test-grail-galleri/13348351/
[Hundreds mistakenly told they had cancer due to GRAIL glitch](https://abc7news.com/amp/cancer-test-grail-galleri/13348351/)
I would report the doctor to the state medical board, the lab to CMS, and fight the bill.
Something about this isn’t right. Grail is professionally run – i doubt they are engaging in widespread violation of AK and Anti-Markup laws. I think OP didn’t get the correct answer. OP should call grail and ask to speak to the chief compliance officer. And if not immediately connected ask for (or look online) for mechanism to file a complaint to Grail. They have a formal complaint handling system, it will allow anonymous complaints but you want to be sure to provide your name and number.
I used to think health insurance was a scam, until I become an RN and saw how much abuse do today do on a daily basis for money.
Are you in the US? It is illegal in some US states for a doctor to receive a commission or referral fee such as what you describe here. You would have to look up your state laws or post your state here to be able to address that aspect.
Did you look at what you signed? If that test was on the list of labs, it will probably negate your claim.
Left my last doctor for something similar. I have high deductible and always check price but i always ended up with something added that triples the price. There is a reason i rarely go to the doctor.
I think ANY medical professional would want to stay FAR away from any threat of getting Medicare / Insurance Co. involved for any type of fraud. I would call the doctor back and suggest they cover this bill or you will be making complaints to anyone and everyone you can…the insurance company, the med board, social media, etc.
I would look up stark anti kick back law. I work in the lab it’s massively illegal to exactly that.
You should report this to the Medical College that they are a member of. Reporting to your insurance company or medicare won’t result in any professional impact for them.
File a small claims against your doctor. She will settle.
>,”I don’t want it if my insurance doesn’t pay for it.”
This is not the correct answer. A medical office has no way to determine what is covered by a particular patient’s policy. If you haven’t checked directly with your insurance company, your answer should be a simple, “No”.
Whether there was really a kickback or not (I believe there usually is and they come in various forms) medical providers in general have become more like used car salespeople than anyone focused on actual healing. Getting their billings up has become the main goal in medical care. So we as patients have to do our due diligence and say no to unnecessary procedures and medications. If that fails the suggestions made by paintitblack37 are excellent. Great advice there.
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Sounds like you signed something which could be bad news for you. Also, it’s not the doctors responsibility to know what your insurance covers, it’s yours. You should blatantly refuse any test or service until you call your insurance company first.
Expensive lesson learned- you’re gonna have to pay that bill.
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You should have just said “No” in cases where its ambiguous.