I think my physician committed medical billing fraud. As part of our fertility evaluation, Mrs Happy underwent a bone density scan at the physician's office . I asked the technologist why she was getting it. She said that doctor uses it for research purposes. The technologist said we were under no obligation to pay for it IF our insurance company denied the claim.
I know that no insurance company would pay a claim that was being used for research purposes. The fact they did feels dirty. It feels like medical billing fraud. None of our fertility evaluations were covered by insurance. So I thought nothing of it. Three months later, I received an explanation of benefits indicating that the bone density scan had been paid for by our insurance plan. And paid for quite well.
I have no doubt in my mind that this study was medically unnecessary. I have no doubt in my mind that the only purpose of this study was to generate research data for the doctor's data base. Was this medical billing fraud? Would the insurance company have paid the claim if they knew it was only being done for research purposes? What is my obligation as a physician a patient's husband?
