My husband and I are both on Medicare. Our local drugstore advertised flu shots for $24.99. So we got our shots and didn’t think anything of it until we got our “Medicare Summary Notice” in the mail and low and behold the drugstore had charged an additional fee of $20.43 to administer each shot! This just doesn’t sit right with me. Medicare approved $33.65 and paid that amount for each shot to our drugstore. This seems like outright fraud to me. What do you think?
0 like
Permalink: http://www.vibrantnation.com/work-money/is-this-medicare-fraud/
I'm in the process of divorce. He is finally moving out next weekend. I'm sorry for what happened to you.
Hi there,
Like JKL just noticed this post. Yes, I have a book on the subject. Sharing Housing, A Guidebook for Finding and Keeping Good Housemates Found 
Fraud? No. Pretty hefty mark up? Yes. But the truth is that is still less than your doctor would have charged had it been done in the office.
But what about truth in advertising? Flu shots for $24.99! Seems like just another way to get money from the government.
Thats the confounding thing about healthcare–no one pays the same price, it all demands on what coverage you have. Different payors pay different prices based on whatever is either negotiated or reimbursed.
The govt pays a fixed price for Medicare. The govt determines how much they pay–period. They pay every provider the exact same thing for the same service. THere is no negotiation–up or down.
So actually–blame the govt for overpaying not the the drug store. The govt will pay that price to the drug store, to your doctor, or to anyone else.
It is confounding! Like that old saying….we have met the enemy and he is us!
Walt Kelly. Lol.
Walt Kelly. Lol.
report it, isn’t there an 800 number? The point is not that it is cheaper if you went to the doctor, the problem is false advertisement. I paid $24.99, however, i never showed my healthcare card. I have a $5000 deductible!
sounds like fraud to me.
Sounds like fraudulent advertising to me.
In my humble opinion that is not fraud. That is the result of a service agreement between the vendor who dispensed the shots and Medicare.
As Dallas Lady pointed out, Medicare has agreements in place with vendors to provide services like vaccinations. In those agreements it is usually stipulated as a range of fee that is acceptable for providing those services. I do not think that the aggreements have to be publicly disclosed. So if Medicare and that vendor agree on cost, that is what is considered an acceptable charge. Items like vaccinations are not given out randomly and there are controls on things like that being dispensed.
Did you personally have to pay more than the advertised price of $24.99 out of your own pocket? If you did personally, then I would contact the drug store and complain. Otherwise (if you’re lucky) you may be given an explanation of what providing the actual shots costs that drug store, and my bet would be a lot more than $33.65…
I know that is probably not the answer you wanted to hear, and I am sorry.
I agree, it’s not fraud. Using the analogy of a car repair, it’s like parts and labor. In other words, if you go somewhere where they are advertising a set of tires for $95, that means the tires. Then they add the labor on top of that. It is not unusual for medical services to be split like that. Especially if the drugstore contracted out for a licensed professional (probably an LPN for lower cost) to administer the medication.
If I went to the drugstore and paid cash, I would have paid the $24.99, the drugstore had to do that pesky thing with paperwork (admin costs). The providers know what percentages they would receive so they hike up the request to receive the actual cost-had they submitted just the $24.99 they would have gotten less than that. So the $20.43 fee they charged for admin was reduced to $8.66 and then take out the $24.99 or a combination of the $33.65=the shot and the admin. Medicare would never pay 100% of anything. That is what supplemental insurance is for.
It’s fuzzy. They did advertise the shot was 24.99. And as you stated the administering charge was additional. Yes, they left out information, but we as consumers, patients, etc. must learn to ask questions. If you feel Medicare is being cheated, inform them of the advertisement and they will proceed appropriately. If nothing else, you may simple chose to politely inform the drug store that you felt they left out key information and were surprised when you received your Medicare EOB (explanation of benefits). You can’t be the only one and if this is an oversite on their part, it’s fair that you inform them. If it isn’t, you’ve ‘warned’ them. As you certainly won’t be the only person who complains to their ins. co., if that is what you chose to do. Keep us posted.