The Knucklehead of the Day award

Today's winner is Joseph L. Riley Anesthesia Associates. They get the award for the following.

Nineteen patients insured through Florida Health Care Plans have filed 22 lawsuits against a Maitland-based anesthesiologist group that has exclusive rights to provide services at Florida Hospital Fish Memorial in Orange City.

The patients, represented by Daytona Beach lawyer C. Anthony Schoder Jr., are caught between what Florida Health Care Plans pays for anesthesia services and what Joseph L. Riley Anesthesia Associates charges.

The lawsuits allege that the anesthesia associates have been illegally hounding the patients for the difference, which, in some cases, totals thousands of dollars. The associates are threatening patients that the unpaid bills will go into collections, according to court papers.

The litigants are seeking an injunction to stop the anesthesiologist group from turning the bills over to collection agencies, according to court papers.

The state Agency for Health Care Administration has told the anesthesia associates to stop billing the patients, according to a letter Florida Health Care Plans provided.

Schoder declined to comment on the cases. A call to Joseph L. Riley Anesthesia Associates was not returned Thursday.

Florida Health Care Plans officials say about 70 of their patients have been in a similar situation as the litigants in these cases. The health maintenance organization, which is owned by Halifax Community Health System, has accepted liability for the surgeries these patients underwent, but are willing to pay only "a reasonable rate" for the anesthesia services, said Butch Simpson, president and chief executive officer of Florida Health Care Plans.

"They think they are entitled to five times the Medicare rate," Simpson said. "We're willing to pay two and a half times the Medicare rate."

He said because Florida Health Care has agreed to assume liability for the procedures their patients underwent, the patients can't be billed for the balance of the procedures.

"They should be filing a claim against us" for the balance, Simpson said. "We'll pay whatever a court tells us is the reasonable rate for payment."

It has been TFM's personal experience that medical providers try to put the screw to both patients and the government. How about this big health provider? Or this medical school? Or a local MRI testing center in Florida? All innocent mistakes are they? In 13 years of being a cancer patient, I got tales to tell. I don't think any of these mistakes are innocent, but deliberate attempts at fraud and overbilling.

This medical provider was told to cease their billing, but they continue to do it. That's why Joseph L. Riley Anesthesia Associates is today's Knucklehead of the day.

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