Why are Medical Costs so High?

If you have ever found yourself sifting through medical bills that seem overwhelming, you are not alone. This is frequently true when trying to make sense of the costs associated with an emergency room visit. After all, no one plans a visit to an emergency room.

medical billsWhen faced with expenses that seem unreasonable, it is important to consider factors that might offer some sort of explanation as to why medical costs are so high. A blog in the Washington Post discussed a recent Rand Corporation study exploring the purported relationship between healthcare costs and medical malpractice.

Is there a connection between healthcare costs and medical malpractice?

The theory behind medical malpractice or “tort reform,” advanced in recent years by the insurance industry and special interest groups, is that physicians order unnecessary tests to protect themselves from the risks associated with medical malpractice. This is sometimes referred to as “defensive medicine.” The theory begs the question:  are all diagnostic tests ordered in emergency care medically necessary? The question is admittedly complicated, given the urgent nature of medical care provided in emergency rooms. Medical personnel must be able to rule out certain causes of symptoms for patients that they may not have a complete medical history of. Still, the question remains whether all tests are required for care, or if some (or many) tests are performed only to protect doctors from lawsuits.

The New England Journal of Medicine recently published an article regarding the Rand study, titled The Effect of Malpractice Reform on Emergency Department Care. The study compared costs associated with emergency patient care in states that have passed laws making it more difficult for patients to sue their doctors for negligence, compared to states without similar laws. The results of the study show that strict medical malpractice laws have made little difference in the spiraling cost of medical care. The study therefore goes a long way towards debunking the theory that the fear of lawsuits is the driving force behind rising healthcare costs.

While some individuals battle with a sea of bills, others are left sifting through a sea of research and data to determine how care has become so expensive. While defensive medicine may not play a role, perhaps more important is the connection with healthcare billing fraud. More information can be found regarding fraudulent billing of Medicaid and Medicare in the Primer on Whistleblowing in Healthcare , co-authored by Brownstein & Nguyen attorney Jay Brownstein. If you suspect that your medical expenses are unreasonable as a result of billing fraud or overbilling, contact our trusted Atlanta attorneys for a consultation about healthcare whistleblowing. Brownstein & Nguyen’s Georgia lawyers are experienced in handling complex litigation matters and have represented and consulted with clients in whistleblower cases.