Veterinary Billing Without Oversight or Regulation

Medicare, Medicaid, and private insurance companies carefully sift through human health care bills looking for obvious cases of upcoding, bill-padding and billing for medically unnecessary work.

Under federal law, the consequence of ripping off Medicare and Medicaid can be triple damages plus statutory fines of $5,500 to $11,000 per violation. As a consequence, there are a lot of disincentives to ripping off America's health care system -- billions of them, in fact.

And yet, as we all know, the health care system is routinely ripped off, nonetheless.

So, one wonders what goes on in the arena of veterinary care, where the are no sanctions against fraud, where "catch me if you can" is the traditional billing model, and where health-based outcomes are not tracked at all.

Is your veterinarian killing a higher-than-normal number of dogs while putting them under anesthesia for dental work that is not even medically-necessary?

Who knows?

When your vet spays young bitches, do a higher-than-normal number later develop incontinence?

Who knows?

Is your vet charging twice a much for a neutering as other vets in the area? Does he or she vaccinate more often, test more often, and suggest expensive and extraordinary interventions more often than other vets in the area? Do the health outcomes justify this practice?

Who knows?

The simple truth is that idea of results-oriented medicine and anti-fraud controls has simply not made its way to the field of veterinary care.

As a consequence, the only thing that stands between you, the customer, and being ripped off, is your veterinarian's conscience (which the AVMA is working hard to erase) and your willingness to get educated and "just say NO" to price-gouging and medically-questionable billing.

How much bill padding, price-gouging and waste goes on in American veterinary care?

Who knows? All anyone knows for sure is that there are virtually NO legal or regulatory disincentives to upcoding, bill-padding, kickbacks, price-gouging and billing for medically unnecessary work in place at the moment.

And if we look at human health care where results-oriented medicine is closely tracked, and where there are sizable legal and regulatory disincentives to fraud and price-gouging, the numbers we find here are not comforting.

Consider this: a new analysis from PricewaterhouseCoopers puts the value of the waste sloshing around in the American human health care system at a whopping $1.2 trillion a year.

That's trillion with a "T," and that number represents HALF of all human health care expenses in this country.

Consider the relative per-capita cost of health care in various countries that are a lot like us to be found on page two of the PwC report (click on table below to enlarge).





As you can see, ALL of these countries have better health care outcomes than we do here in the U.S., and yet these countries are paying less than HALF what we are paying for health care in this country.

What the hell is going on?

Well, the short story is that Americans are being ripped off blind. Back in 1991, I was the person who pitched the story to Mike Wallace at 60 Minutes about how drugs made in America were being sold for one third-the price to patients in Canada, Mexico, Europe and and Asia. Why were the drug companies ripping off U.S. customers? Simple: they could.

Over the last four years, as part of my day job, I have been researching, writing and commenting on massive Medicaid frauds by drug companies, huge frauds perpetrated by pharmaceutical company middlemen, massive hospital frauds, and the payola politics that make it all go around.

I know what percentage of certain types of doctors are on the take from drug companies, how much the kickbacks are on each knee and hip replacement, how ambulance companies and "bill mills" cheat Medicare and Medicaid, and how simple billing scams can add thousands of dollars to the cost of a simple overnight hospital visit.

And yet the questions hang out there ..... Are human doctors less honest than veterinarians?

Are veterinary hospitals more honest than human hospitals?

Are the drug and device makers who sell their stuff to vets an entirely different lot from the human-drug and -device counterparts?

Or, could it be (heaven forfend!) that we dog owners are often ripped off at the vets office, just as about as often as we are at the doctor's office, the pharmacy, and the hospital?

More on that later. In the interim, a word to the wise (which is generally sufficient): Caveat emptor.

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