u/TurninOveraNew

I believe hospitals in the USA, may be convincing parents to get unnecessary testing for their children so they can bill insurance.

Though what I am about to describe happened in November of 2021, I was reminded of it today and once I thought about it more, it does not make sense.

My father had a genetic heart defect, though I do not have any heart issues. Due to the family history, we had special cardiac related ultrasounds done twice prior to my sons birth, specifically looking for any heart abnormalities in him. There was also an EKG performed on him while we were still in the hospital after his birth. At his first pediatrician visit a few days after leaving the hospital, they also checked for any heart related issues. Everything came back clean from the very beginning. No issues were ever found.

Approximately 3 weeks after his birth, my son was diagnosed with pyloric stenosis. We were referred to a hospital for surgery. While in the hospital awaiting surgery, a doctor came in, listened to his heart with a stethoscope, and said something to the effect of “I think I hear a murmur. We should get it checked out to be sure.”

Obviously, in our distressed state, we did not question it. We had the EKG done and it came back without any issues.

I was recently telling someone about all this, and it suddenly stuck me. I don’t believe the doctor actually heard a murmur. I think it was an easy way for them to bill insurance.

Think about it. If a doctor comes in and says your child might have a heart issue, obviously you are going to do what they say. An EKG is a quick, painless, noninvasive procedure that they can bill insurance for that no parent is going to deny or question. It is the perfect cover for getting more money out of insurance.

Had we not had the extensive heart related diagnostics on my son prior to the doctor saying there might be a murmur, this thought would have never crossed my mind. It seems strange to me that everything before and after the doctors mention of murmur all came back normal.

I contacted my state insurance fraud department, and they said to contact my insurance company fraud department. When I did, the insurance company told me to contact the state fraud department!?!

If this is in-fact what they are doing, I would imagine that this is a common practice, not just at this hospital, but at every hospital in the country, especially in pediatric settings where parents are under significant stress and will do whatever doctors say.

Production Data Center for Fortune 500 Company

Hospitals charging for unnecessary tests for kids