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Officials slam private practice for billing out-of-network patients

Officials recently accused an anesthesia practice of failing to disclose information to patients prior to providing care. This information included the likelihood that their services were out-of-network for billing purposes because the group did not participate in the same health insurance plans as the facilities where they provided care. The Attorney General’s Office (AGO) also claimed the prices the group charged were “unfairly high” and not reasonable for the services provided.

What were the penalties?

When faced with the accusations, the group chose to pay a fine and move on. As part of the agreement, they do not admit any wrongdoing or liability. They agree to pay the fine, stop collecting for out-of-network and uninsured patients who currently owe and fall within the group that was part of the accusations. The group also agreed to an assurance of discontinuance.

The group also assured the AGO that they were currently in the process of dissolving the practice. As a result, they also agreed to no longer carry on business operations except as necessary to wind up operations.

How much was the fine?

The fine was substantial. The group agreed to pay $260,000. Of that sum, $185,000 was set aside as a civil penalty while $75,000 constituted restitution to patients who suffered harm as a result of the billing practices and to the AGO to help build initiatives and enforcement to reduce the risk of similar issues from other groups.

The case serves as a reminder of the importance to review billing practices. A failure to follow applicable regulations can result in serious fines, as shown above.