22 March—The Connecticut General Assembly is considering legislation to permit the sale of delinquent state tax debt to private collection agencies. Revenue Services Commissioner Mark Boughton, former Republican mayor of Danbury, was surprised to discover recently that it can’t be done it as things stand. I was surprised to discover that municipalities can do it as things stand.

It’s a bad idea for any number of reasons. Especially for the state, which, judging by recent history, likely couldn’t negotiate a decent deal with the debt collectors. Then there’s the bupkes the state would sell the debt for and the specter of private enterprise abusing taxpayers as only government has traditionally done. On the other hand, it’s capitalism in action.

My only experience with debt collectors was a few years ago over a ten-dollar medical bill. I won’t identify the medical business except to say that customers—doctors have patients, businesses have customers—call it ProWealth and it has three discrete entities operating out of the same address in Farmington, a C corporation (Inc), a professional corporation (PC), and a limited liability company (LLC) for its ACO.

ACOs are accountable care organizations, which the Centers for Medicare & Medicaid Services (CMS) tells us “are groups of doctors, hospitals, and other health care providers, who come together voluntarily to give coordinated high-quality [CMS’s word, not mine] care to their Medicare patients.” There’s obviously a tax advantage in being an ACO.

(Centers for Medicare & Medicaid Services, Centers for Disease Control, National Institutes of Health? Pluralistic government in action.)

Anyway, I qualified for a free—no copay or deductible—abdominal aortic aneurysm screening. So of course I had it done. But then I got billed for a ten-dollar copay. My primary care physician, who a few months earlier noticed that I had copaid 20 dollars for two annual visits that were supposed to be free and insisted on refunding me the Jackson out of his pocket, told me he’d take care of it.

But he couldn’t, so he offered to give me a Hamilton. Thanks but no thanks. My diligent research revealed that the diagnostic procedure I underwent had been upcoded when ProWealth billed Aetna. Hence the copay. Upcoding is the term of art when providers bill insurers for more than they should. We don’t need to go into the etiology of upcoding, save to remark that it’s a fairly common illegal practice that more often than not goes unpunished. Even when it’s discovered. Like Medicare and Medicaid and medical insurance fraud in general.

By improperly upcoding my sonogram and interpretation, ProWealth stood to gain my copay and another 30 dollars or so. That’s all. But multiply that by all its customers and procedures that don’t involve copays for customers to notice or subtelties for insurers to flag. In all events, wouldn’t you think that upcoding lots of little things would be less likely to attract attention than upcoding fewer big things?

(After my father died in 1996 from the abdominal aortic aneurysm he knew he had for decades but didn’t trust his colleagues to patch, I received bills that Prudential refused to pay providers. Big bills for big procedures. Prudential refused to pay because the bills were for double and triple procedures, mostly diagnostic, none of which were necessary, some of which, as I discovered, hadn’t even been carried out. Something like $35,000 between four specialists. When threatened, I told the quacks to come and get me. They never did. I also saved Prudential several thou. But not a word of thanks.)

A few months passed. The buggers in Farmington totally ignored my emails and phone calls. But they were nice enough to threaten me with collection. A new experience. So I filed a Medicare fraud complaint with the CMS OIG—Office of Inspector General. After about month, CMS OIG told me, in essence, “Ten dollars? You’ve got to be kidding, schmuck!”

Shortly thereafter I received a letter from a collection agency in Danbury. I had a pleasant chat with a couple of operatives there and learned that my piddling debt was part of a tranche ProWealth had unloaded for pennies on the dollar. But my tenner was particularly small anyway, though not the smallest they’d seen. Did I want to pay it then?

Of course not. So, as I recall, if I provided paperwork from Aetna to back me up, I’d be exonerated or whatever it’s called when a debt is satisfied. I did and I was.

I’d like to tell you that the bastards at ProWealth had nothing to do with it. But when I received my next monthly explanation of benefits from Aetna, it appears that it or they paid ProWealth the ten-dollar copay it or they said I wasn’t responsible for because of the upcoding. And—to add perverse absurdity to the whole deal—on top of that, Aetna slipped ProWealth even more than the procedure as illegally upcoded called for . . .