Is this billing fraud legal? (California) (California) (Cali

[4anewusers]

Question: How are some medical providers in workers compensation getting indicted for over-billing when according to this article it is a common practice and legal?

https://www.nytimes.com/2019/12/07/opin ... i=80486938

[jpod]

The article is about health insurance billing not workers' comp. Workers comp is not private practice, ii is a state mandated program that imposes rules; there is an official medical fee schedule and a requirement that medical services be both reasonable in terms of cost AND medically necessary. In WC Medical providers are not allowed to enter into a contract with the WC patient.

In health insurance the doctor can set their own fees which does not necessarily match the amount the health insurance covers. The patient usually signs papers which is essentially an agreement to pay the doctor the difference between what was billed and what the health insurer paid to the doctor.

[mvucurevic]

To answer your question in the simplest form, the Doctor's who are being indicted for "over-billing" are actually being charged with billing for items and services that were never provided. With regards to "over-billing" the provider is really required to do only one thing and that is bill every payer the same charge, be it Medicare, an insurer, or the patient.