Pluralistic: 06 Sep 2020

Today's links

Doc resigns after his employer charges $11k for a $8 covid test (permalink)

Zachary Sussman is a pathologist who oversaw covid tests at 4 standalone ERs for Physicians Premier, but he resigned in horror after he got a $8 covid test at one of the company's locations and then they billed his insurer $10,984.16 for it.

In an outstanding investigation for Propublica and the Texas Tribune, Marshall Allen reveals how both Physicians Premier and Unitedhealthcare – the nation's largest insurer – feed into this system of fraudulent price-gouging through a combination of greed and indifference.

There are elements of this that are just straight-up fraud: the coding on Sussman's bill includes charges for procedures that simply were not performed, like an antibody test, an in-depth investigation, a problem-focused history, a nasal swab, etc.

To make the fraud even more ghastly, Physicians Premier (and USA Emergency Centers, who license the name) overbilled for these procedures that were never performed: they charged $3200 for the nonextistent antibody test that they list at $75.

The vast majority ($8,884.16) came in the form of a "facility fee," a major source of emergency care grift that crops up whenever private equity funds get involved in emergency care.

When you hear about someone getting thousands in out-of-network fees for an icepack, that's almost always a "facility fee."

In this case, the fraud and facility fee were compounded by the fact that Physicians Premier/USA Emergency operate "standalone ERs" that are 100% out-of-network, meaning that they bill crazy sums that are either negotiated down by insurers or passed along to patients.

The final component of this incredible fraud comes from Unitedhealthcare, the largest insurer in the country. They have been gouging like crazy during the pandemic, racking up $6.6B in earnings in Q2-2020 alone. This has drawn a ton of scrutiny and criticism, naturally.

Which may explain why the company simply greenlit this obviously fraudulent charge (and why their internal fraud investigators were totally blase when Sussman called them up).

They're making incredible, towering sums profiteering off the pandemic and sending it to shareholders and execs, rather than upgrading their creaking anti-fraud systems. They don't want to call attention to any of this and mess up their good thing.

The CARES Act mandates insurers to pay for (many) covid tests, and the grossly inefficient, wildly profitable health-care system has used this as an excuse to gouge the grossly inefficient, wildly profitable insurance sector.

Nobody (except plutes from the shareholder class) wins when these two giants wrestle one another.

The lesson of this awful scandal is that a broken, for-profit health-care system can't be fixed by mandating care.

Without a publicly accountable, public-spirited health care system, the CARES Act's mandate to pay for testing was just an invitation for the grossly unethical for-profit care system to gouge insurers.

The exception to this is Medicare, which caps pricing for antibody tests at $42.13. Ironically, Sussman told Propublica he only came forward because he opposes Medicare for All and fears that abuses will give the existing system a bad name.

"If instances like these go unchecked it will provide more ammo for advocates of a single-payer system."

Physicians Premier Austin

(Image: Physicians Premier Austin)

This day in history (permalink)

#10yrsago Gibson's ZERO HISTORY: exciting adventure that wakes you to the present-day's futurism

#10yrsago Latest leaked draft of secret copyright treaty: US trying to cram DRM rules down the world's throats

#1yrago Regular expression crossword puzzles!

#1yrago 10 bipartisan Attorneys General launch antitrust investigation against Facebook

#1yrago Robert Bork is the architect of the inequality crisis

#1yrago Gaming's #MeToo moment: male fragility versus women's fundamental rights

#1yrago University of Kansas's Campbell Conference changes its name to the Gunn Center Conference

#1yrago Australia wants to kill consent requirement in proposed data-sharing legislation, calls it "nuance"

#1yrago Information security and warfare metaphors: a toxic mix made in hell

#1yrago Amazon's plan for traffic deaths from same-day delivery: deflect blame to anonymous subcontractors

#1yrago Gallery of Hong Kong protest art: #BeWater

Colophon (permalink)

Today's top sources: Naked Capitalism (

Currently writing: My next novel, "The Lost Cause," a post-GND novel about truth and reconciliation. Friday's progress: 520 words (57818 total).

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When life gives you SARS, you make sarsaparilla -Joey "Accordion Guy" DeVilla