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Ask A Frustrated Nurse Episode 31
Jun 18, 2022

THS & The Healthitude Academy

You are safe here. We are here to help you and your family, navigate the Healthcare System, make...



A Physician Group of clinics in Illinois reject the Blue Cross of Illinois Contract due to poor reimbursement and has continued to see their patients as they address their concerns. I am sure that the reimbursement is a ridiculous amount and one of the reasons is not being able to recruit staff physicians because of the poor reimbursement. While the Clinic is still negotiating the contract they are working with their longstanding patients to treat them while they are out of network. Group of physicians that care about their patients and the continuity of care.

The physician pleads guilty to fraud billing Medicare, Medicaid, and Blue Cross for billing Office visits that were not visited by her, but by her unlicensed office staff. It is one thing to go into the office for a dressing change, or wound check, but those cant be billed. However, these patients were receiving Prescriptions for controlled substances without a legitimate purpose. She has surrendered her DEA and will no longer be able to prescribe DEA meds. She pleaded to one count of medical fraud and a fine of $500,000. She can also be sentenced to up to ten years. United Healthcare Group is being accused of forcing physicians out of network to recruit them into an Optum Group. This claim is coming from the group Envision Health. More crazy contract negotiations and threats of poor reimbursement rates by yet another insurance provider. A surgery center in Florida files a lawsuit claiming United Healthcare has repriced and underpaid. Paying only $16,125 on a $193,000 total charges. It would be interesting to know the contract and what they should be paid. This surgery was pre-authorized. Finally, Optum (United Healthcare Group) received authorization to buy 30 locations with a price tag of $73 million, Increasing the offer to $223 million to include the charity work. They are 645 physicians included in the battle. LHC is a home health set to be purchased by Optum(United Healthcare Group) some board members are not happy with the sale. Again, I don't think Insurance companies should be the deliverer of healthcare. My humble opinion.

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