Hartford Medical Group Billing Investigated As Two Patients Thrown Out Of Practice

June 12, 2010
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One of the largest medical practices in Connecticut is under investigation by the state attorney general’s office for its billing practices after two patients were thrown out for creating a fuss over being charged additional office visit fees as part of their routine physicals.

Two West Hartford residents were told by Dr. Kent Stahl, CEO of Hartford Medical Group, which serves 50,000 patients, that they were no longer welcome in the practice.

Dr. Kent Stahl

In one case, he told Darlene Susco, the owner of a marketing firm, that he would allow her back only if she withdrew her written complaint to Attorney General Richard Blumenthal.

The issue – which the two complainants believe involves many more patients and possibly many more medical groups and doctors – is about what is covered when patients have an annual physical, which are often fully covered by insurance, and what services patients and insurance companies can be charged extra for. Their position is that the physical should include an update on all medical issues, and any necessary prescriptions.

Dr. Stahl insists his billing practices are proper and legal, and said he believes the attorney general’s office will agree with him. “In general, both situations involve simultaneous charges for preventative services (exams) and disease evaluation and management services,” Dr.

Stahl wrote me. He also said he has not waived fees for anyone who complained.

However, that does not appear to be the case, as the attorney general’s office provided me a statement saying that Blumenthal is investigating based on the two complaints from the West Hartford residents as well as from a third patient served by the practice, which has offices in West Hartford, East Hartford, Glastonbury, Avon, Windsor, Wethersfield, Manchester and Enfield.

“My office has received complaints about Hartford Medical Group alleging excessive and unjustified billing for medical services,” the attorney general said in a written statement. “In some cases, consumers received bills for what they believed were routine physicals covered by insurance. The allegations concern potentially unjustified charges added to consumer bills for services that should have been included in the physical or were never provided.”

The most serious issue involves Don Reder, a professional mediator and arbitrator, who contacted me last year after he received a $90 bill for an office visit from the Hartford Medical Group, on top of what his insurance carrier paid for his annual physical.

Don Reder

Reder said he was rejected by the practice last year after he began questioning why he and his insurance carrier were being charged twice for the same visit.

While Dr. Stahl and John L. Fundock, chief operating officer of the Hartford Medical Group, said they can’t discuss specifics of Reder’s medical issues, they insist he was billed properly because he had brought up additional issues beyond his basic physical during the examination.

They also accused Reder of being belligerent and “nasty” in his complaints to staff and said Reder falsely claimed that he was an attorney. They also said Reder initially refused to pay his bill. It was for these reasons he was told to get another doctor, they said.

“I informed him quite clearly that he crossed the line in the content and tone of the conversations with me and my assistant, and that as a result of that he would be discharged from the practice,” Fundock wrote me in an email. “Even though, as he stated, he is a highly paid arbitration lawyer, at $200 per hour plus, we do not tolerate verbal abuse.”

Reder, who is not an attorney, denies ever telling them that he was and said his complaints were made in the tone that any consumer would use questioning what they felt was an improper bill.

For Reder, with homes in West Hartford and in Florida, the fight is not about the $90 bill, which he said he paid. He has been conducting his own investigation into his bills as well as the practice. He said he knows of others who have also been charged twice, and that some of them succeeded in having the second charge removed.

He said that he learned from his insurance carrier that he or his insurance company had been billed twice for the past four or five physicals, once for the actual physical and once for treatment of cluster headaches, which Reder said he has not had for several years.

“The record of the physical is inconsistent with the HMG billing and, despite not having them (cluster headaches) since 2004, they have been billing a separate charge for the management of these for years,”

Reder wrote me.

Susco said that prior to last year, the charge to her insurance company for her physical included standard wellness care, but starting last year Hartford Medical broke this part out and charged her $125.21 in a separate bill, while reducing the cost charged to her insurer for the annual physical.

“This works out great for Hartford Medical Group because they’ve found a way around accepting assigned payments for standard wellness care, and it makes no difference at all to Anthem, because they’re only paying the assigned amount no matter what the bill is,” she wrote to Blumenthal. “But my 100 percent-covered standard wellness care is now costing me $125.21 – before any standard blood tests are performed.”

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20 Responses to Hartford Medical Group Billing Investigated As Two Patients Thrown Out Of Practice

  1. [...] This post was mentioned on Twitter by George Gombossy and Viktoria Sundqvist, The Middletown Press. The Middletown Press said: RT @ctwatchdog: Hartford Medical Group Billing Investigated As Two Patients Thrown Out Of Practice http://bit.ly/bUMmig via @AddToAny [...]

  2. Joe Middleton on June 13, 2010 at 8:10 am

    Re: Medical Office Under Investigation.

    Attn. Mr Gombossy;

    The trend for medical billing is now in a yearly examine and wellness care. The treating doctor has now found a way to off set co-pays by claiming the examine has gone from one form of treatment to another so as to justify additional billing.

    In the new National Health Care this type of billing will be standard and it appears to be a form of curreption which will in time bankerupt health care.

    • give-me-a-break on June 16, 2010 at 3:55 pm

      hmm, lets think this through

      A – I’m a healthy 38 year old and i go to the doctor for my physical and he bills my insurance company $150

      B – now I’m a 40 year old smoker, with diabetes and high blood pressure. the doctor does my physical, discusses smoking cessation, starts me on chantix, changes my diabetes medicine and starts a new blood pressure medicine – the doctor has two choices – he can do my physical (which is a well exam and counseling and screening) and set up a follow-up visit to handle the smoking, diabetes and blood pressure (in which case he gets paid for two visits) and i have to make a separate appointment for the medical issues, or he can combine both of them in one visit. Is there anybody in there right mind who thinks the doctor should be paid the same for paitent A and B?

      A – Now I bring my car in for a 50,000 mile check-up – the garage charges me $200

      B – My neighbor brings his car in for 50,00 mile checkup – he gets charged $350 because they also did his brakes at the same time –

      hmmm should car owner A and B be charged the same? better call the attorney general!!

  3. Figures on June 13, 2010 at 3:13 pm

    I’m not suprised by this or that Dr. Stahl or Fundock is involved. Was this done by a billing service or did they bring it back in house? interesting. Best of luck to them!

  4. Jojowasaman on June 15, 2010 at 6:59 am

    Last year I went for a doctor appointment with my PCP, and he sent me to an ENT specialist. The total charges submitted by doctors for this event was $5679.00. The total charges paid by my health insurer and my self were $3406.79. The ENT doctor charged us $641, which was settled by the insurer for $526.89, to examine my ears, and scope my ears and sinuses, all of which took about ten minutes. Then, he sent me to get am MRI done, which took about fifteen minutes, and we were charged $4168 for that. We (myself and health insurer) settled on that for $2200.61. It doesn’t matter to me what the insurance pays, or what I pay….what matters is that these charges are clearly excessively obscene. The result of all this is I avoid doctors at all cost, which is sad. But enough said, I’m beginning to feel ill just talking about it.

  5. Jojowasaman on June 15, 2010 at 7:25 am

    ….ok, I am feeling a little better after breakfast. I just want to add that through all the doctor visits, three in all PCP(2) and specialist(1), I was never given any diagnosis, or treatment, and I still have the same issue with my ears/sinuses today, almost 16 months later.

  6. Findellia on June 15, 2010 at 7:45 am

    Note that Tea Bagger Joe Middleton blames Obama’s not-yet-implemented health care plan for the widespread criminal behavior of MDs and insurers. How .. wonderfully … objective … not.

  7. connie on June 15, 2010 at 8:46 pm

    bottoom line you no longer go to the doctors for a physical because if you mention a problem you will be charged EXTRA

  8. Francine Hunter on June 16, 2010 at 8:22 am

    I am in the health care business and I agree that the billing practices are outrageous. How about this one? I went to an MD for a “physical” prior to an examination that would require some sedation. I was never touched by the MD- never was asked to undress- mtyblood pessure was taken and some questions were asked relative to the procedure that would be done. COST? $285.00

  9. give-me-a-break on June 17, 2010 at 9:41 am

    hmm, lets think this through

    A – I’m a healthy 38 year old and i go to the doctor for my physical and he bills my insurance company $150

    B – now I’m a 40 year old smoker, with diabetes and high blood pressure. the doctor does my physical, discusses smoking cessation, starts me on chantix, changes my diabetes medicine and starts a new blood pressure medicine – the doctor has two choices – he can do my physical (which is a well exam and counseling and screening) and set up a follow-up visit to handle the smoking, diabetes and blood pressure (in which case he gets paid for two visits) and i have to make a separate appointment for the medical issues, or he can combine both of them in one visit. Is there anybody in there right mind who thinks the doctor should be paid the same for patient A and B?

    A – Now I bring my car in for a 50,000 mile check-up – the garage charges me $200

    B – My neighbor brings his car in for 50,00 mile checkup – he gets charged $350 because they also did his brakes at the same time –

    hmmm should car owner A and B be charged the same? better call the attorney general!!

    • Don Reder on June 17, 2010 at 9:17 pm

      Hi give-me-a-break. I am one of the discharged patients and, unlike the situation you describe, there was absolutely nothing different in this physical from prior physicals. Happily, there were no new conditions to discuss and my doc, in effect, told me that I was boring…a good thing when one is 62 years old. My issue is simple. My insurance provides for a free annual physical. HMG billed me for a medically necessary office visit for the management of cluster headaches in 2009, a condition that is noted in my doctor’s notes of that same physical as not occurring since 2004! Nonetheless, they have billed me the additional charge for years for the same condition which I have not had for years. Had I gone in with a new condition which required time and attention beyond the ordinary physical, I would not have objected, but that was not the case for either of us who George wrote about. Additionally, HMG was paid by me well PRIOR to their discharging me for non-payment and were paid again by Anthem a week or so later and, despite that this occurred almost one year ago, they have not gotten around to refunding the overpayment. Don

  10. Sally Forth on June 19, 2010 at 6:39 pm

    The doctor’s office is claiming to have provided two services in the course of one patient visit. One service is a preventive exam, and the other is the evaluation and management of a previously diagnosed and ongoing medical condition. The question here is whether the comprehensive physical exam does or does not include the evaluation and treatment or management of a medical condition that is either identified during the course of the exam or that is already known to be part of the patient’s medical history. When the insurer’s payment for the exam is meant to include both components, then billing for them separately is improper. That is a practice known as “unbundling” and it would violate the medical provider’s participation contract with the patient’s insurance carrier.

    Of course, billing for the treatment of a medical condition which is resolved and no longer present (in the case of the patient whose cluster headaches went away several years ago and have not come back) is, arguably, simply fraud.

    For doctors who practice here in the “insurance city”, I gotta wonder if they don’t realize that some of their patients will be quite knowledgeable and sophisticated when it comes to these matters…

  11. Dan on July 23, 2010 at 5:08 pm

    Please tell me that the Chief Operating Officer’s last name is truly not Fundock! He must be the life of the party. Seriously, just more rich guys who cant live on what they legitimately earn. Great reporting.

    • George Gombossy on July 23, 2010 at 5:43 pm

      Its real.

  12. This is ridiculous on August 2, 2010 at 10:01 am

    I went to the doctor for a physical which is supposed to be covered 100% by my insurance. They asked some questions about my health. I told them I had been having trouble with my shoulder. BOOM. I was charged for and office visit and had to pay a deductable. They asked me if I smoked and I said I was trying to quit (End of discussion). BOOM. I was charged $35 for smoking cessation. They asked me to come in the next mornig and get my blood drawn. BOOM. The lab sends me a bill for lab work that is not completely covered by insurance.

    If I go to the doctor should I ask How much does it cost for everything they do or ask? What is the point in having insurance? Why go for a yearly physical if you can’t tell them anything is wrong or discuss anything without being charged.

    Isn’t a physical a full body exam? Give me a break. The health care system is greedy!!!!!

  13. Emma Palladino on October 26, 2010 at 10:01 am

    HMG also charges co-pay for physical, the Aetna plan says no co-pay for that service.

  14. Fired Patient on November 1, 2010 at 7:54 pm

    We were recently discharged as a patient after complaining of a 36$ office vist billled to us and covered by our insurance…we didnt have a scheduled visit nor did we go into the office for a visit. When we disputed the bill, billing told us they would take care of it. A month later another peice of mail came stating we were past due 36$. Again we called the office andwere told that it was a mistake and that they would take care of it. another month goes by and we recieve another bill, this time telling us we were in collections! We called the office one more time and were told we were responsible for it. We asked to speak with the Dr. and he called back and left a message that we were responsible for it. No explanation., We called our insurance company, and they called HMG—and a day later, we were discharged as patients for “failure to comply with a prescribed medical plan”! Ha…that’s the worst part of it…because that is the biggiest lie! And then to ask us not to “seek any other HMG facility for treatment as the ‘trust’ had been broken”. That infuriated us becaue HMG are the liars!
    The AG’s office WILL be hearing from us,

  15. overbilled on April 24, 2012 at 5:45 pm

    I had a run in with Dr Stahl as well. He said he would look into my complaint of double billing. A couple weeks later I received a form letter from him that I owed the amount, no personalized explanation given. I called back and reamed him over the phone. I’m not surprised he didn’t know who I was. This time he did look into my complaint and dropped the extra charge. I agree with another poster, Hartford Medical Group is reducing the charge for annual physicals to insurance companies and adding separate out of pocket charges for patients for formerly covered services. It happened again last year. I was also charged extra for supposedly covered blood tests. My “covered” appointment cost me $220 and I was told I’m one of their healthier patients. I knew something was wrong about their billing. It’s time to change practices.

  16. MjBS on October 2, 2012 at 11:51 am

    I am presently still disputing an “extra” charge for my Jan’12 physical. I was googling something for HMG when I found this article and related postings. This is a little scary that HMG can seemingly double charge and then if you still refuse to pay, they do not allow you to continue seeing your doctor.
    there is something terribly wrong with that!!

  17. Sharmayne Wesler on January 18, 2013 at 12:16 pm

    Did you ever try to get someone to answer the phone 800-856-1974 to resolve a billing error? I must have tried 4 times and left my phone # and never got a call back. I even wrote one of the big shots -guess what happened.NOTHING- This is some really bad business management and they wonder why their payments are so messed up.

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