A former patient has sued Baptist Emergency Hospital in San Antonio and its owner alleging they fraudulently overcharged for lab work to generate higher reimbursements.
This is not a qui tam case, but rather a state court private action. The Plaintiff accuses Baptist Emergency Hospital at Shavano Park of carrying out a scheme known as “unbundling,” which is when a facility bills separately for some or all tests analyzed as part of a panel rather than billing for the panel.
The Plaintiff visited the hospital in December 2018. Although the hospital accepted his insurance, he received a “laboratory” bill for $4,500 nine months later. Most of the charge was related to a metabolic panel and a liver function test, together consisting of multiple components. The suit alleges that the components were billed individually rather than as a complete panel, resulting in a higher bill.
A “Pricing Transparency Document” posted on the hospital’s website in 2018 showed the cost of a basic metabolic panel as almost $754. Only seven of the eight tests in the panel were performed, the suit says, but Keslar was billed nearly $1,221, according to the suit.
The petition alleges that this same unbundling practice is occurring across all Baptist Emergency Hospital facilities. Plaintiff is seeking certification of a class-action.