I have written a lot on this blog about “quality fraud” and how the opaque nature of medical expenses and insurance drives up the cost of care. In the US, we overpay for care based upon the quality of services delivered. Some of the increased cost comes in the form of medical error kept confidential by peer review rules in Hospitals. Some of the increased cost comes from a lack of open competition for rates and charges. I wrote about CMS changes that started in 2018 on this blog here:
CMS is trying to change some of that and the new rules are beginning to go into effect. One of those rules allows to consumers to comparison shop medical billing and reimbursement practices. Here is the link to the CMS page:
CMS Announcement of Medical Expense Transparency for US Consumers
The new rules are far broader than those that went into effect last year requiring hospitals to post their negotiated rates for the public to see. Now insurers must post the amounts paid for “every physician in network, every hospital, every surgery center, every nursing facility,” said Jeffrey Leibach, a partner at the consulting firm Guidehouse.
“When you start doing the math, you’re talking trillions of records,” he said. The fines the federal government could impose for noncompliance are also heftier than the penalties that hospitals face.
