Options for Medical Billing Fraud

i teach part time. My school district wanted a renewed TB test. The city clinic is closed. I scheduled an appointment with my doctor for the TB test. i went for the prick on a Friday and returned the next Monday for the reading. It was all handled by an assistant or technician. At the reading I passed my doctor in the hall, and he waved at me. He may have stuck his head in the door to say "hi'. He certainly never examined me or came near me. I was shocked today to see the billing statements. He billed Medicare and my Medigap plan for about $350, which included a doctor patient visit. Most was paid by the Medigap Insurer, a bit by Medicare. I have a $21 co-pay.

There are paid clinics that give these tests for about $38, but most of them are for specific groups like Asian Health Clinic, etc. which is why I went to my primary care doctor.

Shall I report this as Medicare fraud? Or just let it go.

By the way, looking for recommendations for another primary care doctor.

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For reference, my daughter (20 yrs old) got a tb test a few weeks ago from her primary care practice (Stanford Health) and they billed our insurance (Cigna) $48.00.  Cigna paid $8.67 and we paid nothing.  I am pretty sure they are not allowed to bill separately for the visit in this case -- if you have the CPT codes you can probably google them to learn more (unless maybe there are different rules for Medicare?).  Medical billing is fraught with errors.  Since this didn't really affect your bottom line, you could definitely ignore it.  But if it's going to gnaw at you (which I would totally understand), call the billing department at your doctor's office.  It could be a simple clerical error.  If you're still not satisfied, call your insurer.  I have found that true errors are usually eventually caught in an audit process on one end or the other (even months down the line you may receive an updated billing statement from your doc, or a revised EOB from your insurer).  

Hi. I think your instincts are good and that this is likely to be fraud. Please take the time to report. You can report fraud by phone to Medicare. If you don’t report it…it will just keep going on. We’re all paying for fraud.
1-800-633-4227. Thx!

I appreciate your concern and sticker shock.  However PLEASE do not report this practice as fraud.  I am a physician--practice public health not clinical medicine--and am a Health for all --with Bernie on this one.  BUT the reimbursement policies in this country are INSANE (Medicare can get away with paying pennies on the dollar for actual cost) and the bureaucracy is astounding.  Let the bureaucracy go after the folks bilking all of us for millions with truly fraudulent billing, and take a deep breath over what this practice has chosen to do for likely their financial survival--(assuming they are an independent practice, and this isn't Sutter-- if it is-Sutter-go ahead and report them!!!)

At UCSF (where I work) “assistants or technicians” are not allowed to place TB skin tests (PPDs) or read them (i.e. evaluate for a skin reaction) - you have to be a designated reader, which is a nurse manager, a nurse practitioner, Physician Assistant, or MD. I’m assuming someone in one of these roles conducted your visits, in which case the clinic needs to be reimbursed for their time and care. Who else would pay if they didn’t bill your insurance (Medicare)? If it was a mid-level provider (NP or PA) the visit would have been supervised by the MD (in the office, not necessarily in the room), but the MDs name would probably end up on the bill/charges. 

This is our broken medical system.  After something similar happened to me I always ask "How much is this going to cost?" before receiving any treatment.  My dentist does this before I see her, (and I have insurance.)  Medical doctors should do the same.