Lieff Cabraser is investigating complaints that HCA Healthcare is overcharging patients by improperly applying its pay-now discounts. Under the pay-now option, HCA member hospitals give patients a 10% discount for making immediate payment during a hospital or emergency room visit. The charges are based on estimates, however, as the hospital doesn’t know the real charges until they send the bill to the patient’s insurer.

The alleged fraud occurs when patients overpay via those estimates — when the care ends up costing less than a patient paid via the pay-now option, HCA does not apply the discount to the overpaid amount. The chart below illustrates the problem as reflected in a sample procedure with an original estimated cost of $1,000 that is ultimately determined to cost the patient only $400.

This is just a single example. Had the hospital’s original estimate been accurate, a patient opting for the pay-now discount would only have paid $360. But HCA ends up billing the patient $400 for the visit because HCA fails to refund properly. Patients allege the deceptive practice allows HCA to improperly pocket the 10% discount that should have been added to the refunded overpaid fee – 10% of the difference between whatever the hospital’s original estimate was and the actual visit cost.

While the individual improper overcharges can seem minor, when scaled across HCA’s 174 hospitals and 119 freestanding surgery centers any improper overbilling may reach into the millions.