Organized crime has really branched out. Organized crime is intrinsic to U.S. healthcare industries.

"corruption is now estimated to consume a third of U.S. health care’s waste, the sum total of which is greater than the entire amount devoted to health care in 90 percent of countries globally.”

“The patient: Travis Warner, 36, is self-employed and bought his health plan from Molina Healthcare via HealthCare.gov.

Medical service: Two "COVID tests" for the coronavirus — a diagnostic PCR test, which typically takes a few days to process and is quite accurate, and a rapid antigen test, which is less accurate but produces results in minutes.

Total bill: $56,384, including $54,000 for the PCR test and the balance for the antigen test and an ER facility fee. Molina's negotiated rate for both tests and the facility fee totaled $16,915.20, which the insurer paid in full.

Service provider: SignatureCare Emergency Center in Lewisville, one of more than a dozen free-standing ERs the company owns across Texas.

What gives: Throughout the COVID-19 pandemic, stories of shockingly high prices for coronavirus tests have abounded. A recent report from an insurance trade association notes that "price gouging by certain providers continues to be a widespread problem." Warner's PCR bill of $54,000 was "astronomical" and "egregious," according to health policy researchers we talked to.

Yet it's perfectly legal. For coronavirus tests — like much else in American health care — there is no cap to what providers can charge, says Loren Adler, associate director of the USC-Brookings Schaeffer Initiative for Health Policy.”

MORE AT:

NPR

The Bill For His COVID Test In Texas Was A Whopping $54,000

September 30, 20215:00 AM ET

aneri pattani

“Organized crime and the U.S. health care industry have more in common than might be immediately apparent. Both provide goods and services for which there is high, mostly inelastic demand—conditions ripe for profiteering. Both market sectors have been subjected to tight regulatory controls, which likely provoked their matching supply-side consolidations to a few big players. And with such massive profits at stake, competition among the few remaining players escalated corruption in both sectors to previously unimaginable extremes — corruption is now estimated to consume a third of U.S. health care’s waste, the sum total of which is greater than the entire amount devoted to health care in 90 percent of countries globally.”

MORE AT:

Medpage today’s KevinMD

What do organized crime and health care have in common?

MAY 8, 2019