US Beacon

CASUS HEALTHCARE LLC and Legacy ER & Urgent Care in Prosper Texas. I have been reaching out to you all for months. First, when we called to ask if you were an urgent care vs ER (we knew the answer but needed clarification from you by phone on a recorded line) you stated you were an urgent care by day and ER at night…🤔. I’m working on a bill from you all and your billing service company, 360 Medical Billing Solutions in Oklahoma hung up on me when I asked about billing and when I called back they wouldn’t answer…for days I tried but would not answer nor respond to my 10 emails. My question is, my client paid CASH to your facility during the day when she was seen by a nurse practitioner for a kidney stone. Here are amounts she paid and is still being billed. Payments made by Ms. ***** to you- $2,493.58 cash for a LEVEL 5 ER- far from a level 5 ER Visit during the day (urgent care) $200.00 "copayment" at time of service $3,946.00 CASH egregious CT cash $232 CASH for an xray with no double procedure dis $589.58 CASH for an IV-integral to service $183-IVCASH $63.70-IVCASH $161.20 CASH $27.20CASH $14.30 CASH $104.20 CASH ***** $35.00 CASH $8,049.76 CASH $7,889.86 CASH $442.41 ALL CASH AND INSURANCE HAS PAID YOU TOO! You charged an office visit a level 4 ER. These visits were not a level 4 or 5 ER visit. It was urgent care, during the day, and you are still sending her bills for over $3000.00. She has paid you CASH for over $25,000. Can someone that will not hang up on me when being questioned please reach out. I would like to understand your coding, billing, process, dr vs practitioner, medical necessity, why you did not offer discount with cash price and of course since you are a free standing clinic, what prices you are comparing this to because surrounding area is quite different. [email protected] Your office said to call billing, billing hung up after being questioned….Please reach out. I truly do not want to have to report you, surely this is a mistake and you all will rectify and reimburse. Thanks— Office of Texas Governor Greg Abbott Texas Attorney General Office of Inspector General Texas Department of State Health Services

Prime Healthcare Services, a California-based hospital chain, has agreed to pay $10.25 million to settle allegations of kickbacks and false billing. The settlement resolves claims that Prime Healthcare engaged in improper financial relationships with physicians, leading to the submission of false claims to Medicare and Medicaid. Prime Healthcare Services has previously faced legal challenges related to its billing practices. In 2018, the company and its CEO, Dr. Prem Reddy, agreed to pay $65 million to settle allegations of false claims to Medicare by admitting patients who required only less costly, outpatient care and by billing for more expensive patient diagnoses than the patients had. Does anyone question their diagnosis now? These settlements are ongoing concerns about fraudulent activities in the healthcare industry and the enforcement actions taken to address them. Healthcare providers are reminded of the importance of legal and ethical standards to ensure the integrity of healthcare programs and the trust of the patients they serve. Independent Bill Review #healthcare #independentbillreview #fraudulentbilling #falseclaims us-beacon.com

A recent lawsuit filed by Owens & Minor against Anthem Blue Cross and Blue Shield underscores the critical fiduciary responsibilities of self-insured health plan administrators. The case alleges that Anthem Blue Cross and Blue Shield breached its fiduciary duties by overpaying claims, misclassifying drugs to inflate costs, and withholding pharmaceutical rebates, resulting in substantial financial losses for the plan. This situation highlights the necessity for plan fiduciaries to diligently oversee third-party administrators, ensuring compliance with plan terms and legal requirements. Regular claims audits and a thorough understanding of contractual rights to access plan data are essential practices to uphold fiduciary duties and protect plan assets. #healthcare #plansponsor #fiduciary #ERISA #fraudwasteabuse #independentthirdpartyreview https://lnkd.in/giDxuKeW

Acadia Healthcare is under federal investigation following allegations of detaining psychiatric patients against their will to maximize insurance payments. The company has received a grand jury subpoena and is cooperating with authorities. In response, Acadia plans to invest $100 million in technology and training to enhance patient care. Following these developments, Acadia’s stock has declined by 26.6% this year, contrasting with gains in broader healthcare and market indices. Acadia’s business is built on volume. Its counselors carry caseloads that are sometimes more than double the limit set by state regulators, according to employees and inspection records. With so many patients, the clinics can become assembly lines, offering little more than a cup of methadone. Clinic directors can get bonuses when their patient enrollment goes up, an incentive that has led Acadia to treat people who do not have opioid addictions but are dependent on other drugs, according to current and former executives and employees. People who are not addicted to opioids can get high from methadone. Independent Bill Review! #healthcare #mentalhealth #fraudwasteabuse #medicalnecessity us-beacon.com https://lnkd.in/gd8tsWzY

FDA Approved….or not? The Office of Inspector General and numerous independent studies have confirmed that approximately 1-2% of claims and about 1% of healthcare spending nationwide are tied to FDA-unapproved medications. Why does this matter? - It’s illegal and violates several state and federal laws, including the False Claims Act if public funds are involved. -These drugs may also be billed at inflated prices or with fraudulent practices. -Plan fiduciaries may face penalties or lawsuits for covering unapproved drugs due to lack of oversight or contractual violations. -Plans are generally prohibited from paying for FDA-unapproved drugs with unlisted or unapproved NDC’s. The recent J&J lawsuit has highlighted that companies and their executives hold personal liability for ensuring compliance with their health plans. If you’re managing a health plan, addressing these issues proactively can help mitigate risks. US Beacon can help you navigate these complex challenges and ensure your health plan remains fully compliant. Contact us to learn more. us-beacon.com #healthcare #pbm #fdaapproved #fda #fiduciary #johnsonandjohnson #fraudwasteabuse #independentthirdpartyreview https://lnkd.in/gEzQ2fn2

A Texas woman faced an unexpected $1,300 bill after having blood drawn at a hospital, a procedure that would have cost significantly less at an independent lab. This incident highlights the substantial price disparities between hospital services and independent facilities, this shows the importance of price transparency and the need for patients to be informed about potential costs to avoid surprise medical bills. Staying informed and keeping up with current healthcare information helps. you to navigate these situations effectively. If you’re unsure, seek guidance from someone knowledgeable, ensuring they truly understand the process. There are a lot of people that are not aware of the issues in healthcare today. Find a reputable advocate! #pricetransparency #healthcare #advocate #stayinformed

My son is an excellent football player, but he’s also a great wrestler. He turned 18 yesterday, and his birthday was spent at school and then his last first match of his senior wrestling season. These last are hurting my heart. My greatest joy on this earth is my kids. I never knew I would be a wrestling mom-to be fully transparent, I didn’t like the singlets they wore, but it’s hard to wrestle in shorts! 🌝 fast forward 5 years and I’ve ordered 5 different singlets, become the wrestling mom for the team, plan the meals, snacks and ensure everyone has what they need at all times. Wrestling food is different because you have to maintain your weight. I believe in giving everything 1000% effort. I would dare anyone who has not wrestled, and thinks you are in shape—go to a high school wrestling practice. Wrestling is more than a sport—it’s a training ground for life, and watching my son on the mat reminds me of the parallels to fighting for change in healthcare. Wrestling teaches resilience, discipline, and the determination to keep moving forward, even when the odds are stacked against you. It’s you against the opponent. In healthcare advocacy, just like on the mat, you face challenges that require grit, strategy, and the ability to get back up after setbacks. Both battles demand accountability, preparation, and the courage to stand your ground for what’s right. I’m proud of the lessons my son has learned through wrestling—lessons that inspire me to continue fighting for fairness and transparency in healthcare. Whether it’s on the mat or in the healthcare system, the fight for something bigger than ourselves is what truly builds character. #iadorehim #healthcare #lifelessons #highlyrecommendwrestling #2pinsinfirstround #216monthsold🥹 #excusetheyelling #biggestcheerleader

This is a bizarre one— A Colorado mom was shocked to receive a bill for $1,877 after her 5-year-old’s routine visit to a children’s hospital, which included an unexpected charge for ear piercing. This highlights the lack of transparency in medical billing, where minor procedures can result in exorbitant costs. Stories like this underscore the urgent need for healthcare reform to ensure fair and transparent pricing in medical services. Would you know the cost of care before saying yes to a service? Ear piercing in healthcare…. Just when I think I’ve heard it all🤭 #healthcare #thirdpartyindependentbillreview us-beacon.com https://lnkd.in/gdfH7k3P

Change happens when voices are raised, not silenced. Thank you, Anthem Blue Cross and Blue Shield, for listening to the concerns and making a wise decision for patients—it’s a significant step forward. Now, imagine the transformative impact of embracing independent third-party bill reviews. Trust is built through transparency, and welcoming collaboration—that’s how we achieve better outcomes and build strong relationships. Let’s see healthcare evolve to truly show it CARES. Lead the way, set the standard, and be the trendsetter in this movement toward meaningful change! It doesn’t matter how strong your opinions are, if you don’t use your power for positive change, you are indeed part of the problem. -Coretta King If you can speak, you can INFLUENCE If you can influence, you can CHANGE LIVES -ROB BROWN Excellus BCBS Anthem Blue Cross and Blue Shield Blue Cross Blue Shield Association Cigna Healthcare MagnaCare Humana #healthcare #independentthirdpartyreview #medicalclaims #bethechange https://lnkd.in/g-NFNGGy

A 15 minute procedure of ear wax removal- Medicare rate $56.00- UC Health/Aetna, a CVS Health Company rate-$1800.00 UCHealth, told 9NEWS Investigates that the amount billed to Desserich was part of a contracted rate it has with Desserich’s insurance, Aetna, a CVS Health Company. “This is their contract,” UCHealth spokesperson Dan Weaver said. “If you have questions about the amount, please reach out to Aetna.” We did. Aetna, a CVS Health Company told us, through a spokesperson, “The services billed by the provider who treated the member were repriced at the contracted rates between the provider and the Aetna, a CVS Health Company Network.” We asked Haig, Fisher and Fox their advice for patients facing big medical bills. Great ADVICE! Haig told us: 1. Ask the medical provider for a line-by-line itemization of how they coded your procedure. 2. Look at your Explanation of Benefits (EOB) from your insurance company to see how your insurance paid (or did not pay). 3. Hospital bills are often incorrect. Make sure your itemized statement meshes with what was actually done. #healthcare #insurance #independentbillreview #medicalclaims us-beacon.com https://lnkd.in/g3fW_sX2