[Jayhawk]

Originally Posted by Villageswimmer

Is there more than one Premier Medical Associates? The reason I ask is that I recalled having read something negative wrt an organization by this name. I googled “Premier Medical Associates Medicare fraud.” I was unable to post the link but it was a DOJ document ordering them to pay $750,000 for fraudulent claims.

Premier Medical Associates Agree To Pay $750,000 To Resolve Claims Of False Billing | USAO-MDFL | Department of Justice

[retiredguy123]

Originally Posted by blueash

Additional information. Florida has a rule regarding HIV testing in a health care setting. The link is HERE . However, the language is not entirely clear as to what is required within a health care setting. The person must be informed a test is being done. An attorney might be able to interpret. The language does not require any pre-test counseling.
The person doing the test, which might be either the doctor or the lab or both is required to notify that the test is "planned". Does that mean simply saying "we are drawing blood for screening tests" is enough? Or is there a requirement to specify that HIV testing is being done? See below. The rule has specific requirements for the person ordering the tests as to how results are to be handled which suggests they are differentiating ordering the test from performing the test. But, if the refusal to be tested must be recorded in the medical record that strongly suggests the burden to inform rests on the entity with the medical record, the doctor.

Model Protocol for HIV Counseling and Testing in Health Care Settings

...In Florida, HIV testing is established and governed by section 381.004, Florida Statutes, Florida Administrative Code Rule 64D-2.004, Internal Operating Procedures, and Model Protocols, all of which are in line with the HIV testing guidelines issued by the Centers for Disease Control and Prevention.

Section 2. HIV Testing in Other Health Care Settings
1. Pre-test counseling is not required
2. Notification
No person shall perform an HIV test without first notifying the person to be tested that the test is planned and that he or she has the right to refuse. Limited exceptions can be found in section 381.004(2)(h), Florida Statutes, and in Florida Administrative Code Rule 64D-2.004(1).
Notification may be oral or in writing. Refusal to test shall be documented in the medical record. Special provisions for hospitals are listed in section 381.004(2)(g), Florida Statutes.
3. Notification of Test Results
The person ordering the test, or that person's designee, shall ensure that all reasonable efforts are made to notify the test subject of his or her test result.

A call to the Florida Health Department which is in charge of this part of the law might be useful.
They may refer you back to the general statute FL 381.004 section (2a) which says this:

2) HUMAN IMMUNODEFICIENCY VIRUS TESTING; INFORMED CONSENT; RESULTS; COUNSELING; CONFIDENTIALITY.—
(a) Before performing an HIV test:
1. In a health care setting, the person to be tested shall be notified orally or in writing that the test is planned and that he or she has the right to decline the test. If the person to be tested declines the test, such decision shall be documented in the medical record. A person who has signed a general consent form for medical care is not required to sign or otherwise provide a separate consent for an HIV test during the period in which the general consent form is in effect. [my bolding]

I would strenuously argue that this paragraph not requiring a separate consent does not relieve the requirement for notification. Those are not the same. But I am not a lawyer. I might just send a copy of this law to the medical office and ask if there is documentation that your parents were informed of their right to decline the test or even informed the test was to be done as the statute seems to require.

If the law doesn't require a separate consent form, it appears that the doctor technically complied with the law. Everyone should know that they can refuse any test or treatment that they don't want. However, this thread is really not about a medical issue with an HIV test. It is about a $500 bill from a lab. So, even if the doctor failed to meet the letter of the consent law, you would still need to make a case that the doctor should pay for the test. Most doctors require all patients to sign a form agreeing to pay for any treatment the doctor does that is not covered by insurance. When you see a doctor, you are basically agreeing to be treated for almost anything he/she believes is medically needed for you, and you agree to pay the cost. I don't think the OP has valid case against the doctor with respect to paying the bill. Some insurance plans would probably pay for the HIV test.

[blueash]

Originally Posted by Villageswimmer

Is there more than one Premier Medical Associates? The reason I ask is that I recalled having read something negative wrt an organization by this name. I googled “Premier Medical Associates Medicare fraud.” I was unable to post the link but it was a DOJ document ordering them to pay $750,000 for fraudulent claims.

Here is the Link
and the key paragraphs

FOR IMMEDIATE RELEASE
Wednesday, May 20, 2020
Premier Medical Associates Agree To Pay $750,000 To Resolve Claims Of False Billing
Tampa, FL – United States Attorney Maria Chapa Lopez announces today that Premier Medical Associates (PMA), a medical practice located in The Villages, Florida, has agreed to pay $750,000 to resolve allegations that it violated the False Claims Act. As part of the settlement, the United States contends that it has certain civil claims against PMA related to PMA’s billing of federal healthcare programs for services that were not medically necessary and reasonable.

Specifically, the government alleges that PMA knowingly billed for higher and more expensive levels of medical services than were actually performed and also billed for certain claims using “modifier 25,” indicating that a separate evaluation and management service was performed, even when there was no such separate service.

Now having linked the settlement it is worth mentioning that this has absolutely no relationship to the concerns of the OP. The medical practice does not profit from the lab testing unless of course it was an in house lab which I don't believe that practice would have for HIV testing. Any profit realized would go to Quest or whatever facility did the testing.

[Stu from NYC]

Originally Posted by blueash

Here is the Link
and the key paragraphs



Now having linked the settlement it is worth mentioning that this has absolutely no relationship to the concerns of the OP. The medical practice does not profit from the lab testing unless of course it was an in house lab which I don't believe that practice would have for HIV testing. Any profit realized would go to Quest or whatever facility did the testing.

Is it possible the DR has an arrangement with the lab that they get a kickback on certain testing?

[rjm1cc]

I use Quest and if a test the doctor ordered is not covered by insurance they tell me the costs and ask if I want the test. They have also stated that their might be a charge and if there is a charge it will be x.
I would tell the lab that since they did not tell you how much the test would cost before doing the test and you relied on then accepting your insurance without any additional charge you owe them nothing.

[retiredguy123]

Originally Posted by rjm1cc

I use Quest and if a test the doctor ordered is not covered by insurance they tell me the costs and ask if I want the test. They have also stated that their might be a charge and if there is a charge it will be x.
I would tell the lab that since they did not tell you how much the test would cost before doing the test and you relied on then accepting your insurance without any additional charge you owe them nothing.

LOL. Good luck with that approach. Medical charges are almost never disclosed in advance. That is the problem with our overall health care industry.

[fdpaq0580]

Originally Posted by Stu from NYC

Is it possible the DR has an arrangement with the lab that they get a kickback on certain testing?

It wouldn't be the first time, I'm sure. Dr might also have a financial interest in the company.
Who knows?

[fdpaq0580]

Originally Posted by retiredguy123

LOL. Good luck with that approach. Medical charges are almost never disclosed in advance. That is the problem with our overall health care industry.

I don't know if I would say "most charges", but we have certainly received separate bills after the fact when the price for care or procedures had been given.
One example was my cataract surgery. Local practice nearby quoted full price for procedure and lenses. After surgery we received bills for the surgery room, recovery, anesthetist,,. Found out the eye group didn't have their own facility and that they rent a surgical facility that bills separately. Those were the things that were not made clear before the surgery.
Another example. My wife had kidney stones and went into the local hospital where we lived in Wa state. We received the Dr bill and the hospital bill, soon after came bill from an imaging company for the xray and use of the room and facilities , a separate bill for the tech,,,. Tech came into her hospital room said Dr wants xray. He wheeled her to a room just a few doors down. Turns out that the imaging company rents/leases the room in the hospital. The tech was a contractor who worked for the imaging company and he did his own billing. We were never told about separate billing. Just thought all was part of the hospital services.
Sign me, "give me ONE price and ONE Bill".

[champion6]

Originally Posted by RARO1

I’m not sure, I know their AARP insurance isn’t accepted by a lot of providers in the villages, hens they have to go up to Ocala

OP said they have Medicare. That being said, I'm assuming AARP is their Medicare Supplement. As we know, if Medicare doesn't cover a charge, the supplement won't cover it either.

[mtdjed]

I get two blood tests per year and never had an HIV test called for on the test prescription. All required test are in a code. If there was never a suggestion of a need for an HIV test, I would start with the test requirements form. Does it specify a code that calls for HIV testing. If it does not, the Lab had no authority and should be challenged. If it does request the HIV test, then you need to question the physician as to why he requested it. My form has codes that I have no idea what they are.

[retiredguy123]

Originally Posted by mtdjed

I get two blood tests per year and never had an HIV test called for on the test prescription. All required test are in a code. If there was never a suggestion of a need for an HIV test, I would start with the test requirements form. Does it specify a code that calls for HIV testing. If it does not, the Lab had no authority and should be challenged. If it does request the HIV test, then you need to question the physician as to why he requested it. My form has codes that I have no idea what they are.

The OP already said that they questioned the doctor and the doctor said the test was routine. The lab just performs the tests that the doctor orders.

[queasy27]

Originally Posted by RARO1

Mother in law has disputed the bill with both the lab and Premier ...

I'm sorry for the troubles your in-laws are having. Getting the runaround like that is supremely frustrating.

Has your mother-in-law tried contacting AARP? They may be able to get more details from Premier and/or the lab and can explain why the claim was denied.

Also, I've never heard of a medical clinic that doesn't accept the same insurance at all their locations in the same area. Hopefully your in laws will find a different practice after this, but if they want to stay with Premier they should call the office in TV and confirm that their insurance is accepted.

Good luck.

[RARO1]

Originally Posted by queasy27

I'm sorry for the troubles your in-laws are having. Getting the runaround like that is supremely frustrating.

Has your mother-in-law tried contacting AARP? They may be able to get more details from Premier and/or the lab and can explain why the claim was denied.

Also, I've never heard of a medical clinic that doesn't accept the same insurance at all their locations in the same area. Hopefully your in laws will find a different practice after this, but if they want to stay with Premier they should call the office in TV and confirm that their insurance is accepted.

Good luck.

I believe it was AARP that told them the Ocala office was the only one that would accept them as new patients, apparently it was next to impossible to find a doctor who would take their plan in TV.

[Alicat5977]

Originally Posted by RARO1

Im writing this on behalf of my mother and father in law, they moved down to TV recently, they decided to go get a new primary DR, they went to Premier medical associates in Ocala.

Premier recommended running routine blood test on both of them. A few weeks later they receive a letter from the lab saying they owe over $500 each for HIV tests, which neither Medicare or their AARP insurance will cover.

Mother in law has disputed the bill with both the lab and Premier but they claim a HIV test is “routine” and that they don’t need to disclose it during the appointment.

I find this ridiculous, why would a couple of 70 year olds with absolutely no history of exposure to HIV need a test?

Mother in law is at the end of her rope and is planing on paying the bill, but I suggested I ask on here to see if anyone has any suggestions.

Don’t know what medical laws Florida has, just moved here. In CT they can’t test you for HIV without your permission, you might want to look in to that a little further. Just a thought. Hope you get it resolved.

[Ele201]

Originally Posted by MSchad

I googled this:
Your doctor can't test you without your consent. HIV tests can only be done with the consent or at the request of the patient. Some states require written consent; for others, verbal consent is sufficient (visit Centers for Disease Control and Prevention for the requirements in your state).

Yes, you’re right! I remember that many years ago, my doctor at the time asked me if I wanted an HIV test. I declined and that was that. It requires consent.