Defending against challenges to reasonable and customary charges.
A consulting auditing firm that reviews hospital charges incurred by members of a union covering several Midwestern states argued in court that a patient should not be required to pay the full amount of charges for services provided by a hospital in a multihospital system. The basis of the firm's argument was that the charges set by the hospital system were unreasonable because charges made by all hospitals are unreasonable. Mistakes made by the hospital during the court action caused it to lose the suit. However, the system won a second, similar suit through better preparation and documentation. This article examines both court cases and suggests methods other hospitals can use to prevail in such cases.
BroMenn Healthcare system, Bloomington, IL.
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Garvin
D000067:Accounts Payable and Receivable; D005375:Financial Audit; D005377:Financial Management, Hospital / Q000331:legislation & jurisprudence*; D017722:Hospital Charges / Q000331:legislation & jurisprudence*; D016365:Liability, Legal; D014481:United States