8 ms·

I wonder what would happen if a patient swapped the form with an identical looking form with different verbiage, making the hospital responsible for any overage

by bshep 4y ago

I wonder what would happen if a patient swapped the form with an identical looking form with different verbiage, making the hospital responsible for any overage past what insurance would pay. I very much doubt anyone would catch it until the bill was contested later. What would a court say? Would it be as legally binding as the standard document? Edit: Or imagine a disgruntled employee in the copy room changing the form?

Peku 4y ago
There is a story is someone doing something similar with their credit card [1]. Not sure how well something like this would fly in the states, but it would be interesting. [1] https://www.nasdaq.com/articles/updated-russian-man-turns-tables-on-bank-changes-fine-print-in-credit-card-agreement-then https://www.nasdaq.com/articles/updated-russian-man-turns-ta...
Vecr 4y ago
It would have to be signed by both sides to count. I've done it before, but you can't just try to sneak things through if they don't sign.
- bshep 4y ago
  In my experience these forms are only signed by patients, so why are they valid in those cases?
  - lisper 4y ago
    The signatures per se don't really matter. What matters in contract law is if there was an actual agreement. The signatures are just evidence that there was an actual agreement. They are neither necessary nor sufficient. This is why verbal agreements can be binding contracts, it's just that these are harder to enforce because it's harder to show that a verbal agreement was actually entered into.
    - DennisP 4y ago
      Well if the patient swapped the form, it would be pretty clear they didn't actually agree to the terms of the original form.
      - cperciva 4y ago
        And if they swap the form in secret in order to trick surgeons into performing an operation which they haven't agreed to pay for, it's pretty clear that they're committing fraud.
        rowanG077 4y ago
        What do you mean "in secret"? The hospital received the form in full detail. There is nothing secret about it. It's like claiming the ToS are secret because none reads it.
        brazzy 4y ago
        No, it's not at all like that. If someone hands you papers to sign and you give them different papers without telling them so, that is clear intent to deceive, which makes it fraud, or at minimum makes the contract void.
        jtc331 4y ago
        People keep saying “in secret” but that’d only be true if it happened after it were filed or some such. Giving someone an amended contract isn’t fraud.
        cperciva 4y ago
        Giving someone an amended contract isn't fraud, no. Giving someone an amended contract while making them think it hasn't been amended is a different matter, though.
        mindslight 4y ago
        Fraud is a strong claim, and it's not clear that there is even an implied contract formed - a contract requires defined consideration. An arbitrary amount conjured out of a hat after service is not well-defined consideration. From my understanding, the medical billing system is so fucked precisely because hospitals bought laws making it so they can arbitrarily bill patients without forming a proper contract (otherwise there would be no way to charge someone who was admitted while unconscious). In the absence of such laws they'd have to fall back to an unjust enrichment claim, under which it would be pretty hard to justify charging someone $25 for an aspirin.
- criddell 4y ago
  When I was registering as a new patient at a dentist, they gave me the standard form that would let them do things like contact my employer if I didn’t pay my bill on time. I stroked a bunch of that stuff out and initialed it. If it ended up in court and they produced that form, would my amendments mean anything? Is it a contract when only one part signs it?
b3morales 4y ago
The hospital would most likely have a very easy argument that since it's not actually their standard form and you didn't tell them about it, they didn't accept the agreement in any way. And they'd probably try to get you for fraud as well. See also https://xkcd.com/1494/ https://xkcd.com/1494/
- kadoban 4y ago
  Negotiating the terms of contracts isn't fraud. Neither is refusing their insane terms, no matter how "standard" they want you to believe they are.
  - brazzy 4y ago
    Swapping forms in secret is the opposite of negotiating.
    - kadoban 4y ago
      That's true. But then again, "sign this or you're dead" isn't negotiating either. The most honest behavior would probably be to mark additions or changes on the form they give you, if they'll fit.
    - ClumsyPilot 4y ago
      What do you mean in secret? The person explicitly talks about providing the hospital with alternative agreement. It is their responsebility to read everything they sign, just like it is the patient's
      - brazzy 4y ago
        The comment I was referring to: https://news.ycombinator.com/item?id=31461781 https://news.ycombinator.com/item?id=31461781 Verbatim quote: "I doubt anyone would catch it". That is not negotiating, that is fraud. It is absolutely not your responsibility to check for the case that you give someone papers to sign and they give you back something different unless they tell you so.
ipython 4y ago
Can’t do that at our local hospitals. The forms are all computerized and your signature is captured on a small tablet.
- est31 4y ago
  What protects you from them swapping the forms then? All you gave them was a picture of your signature, they could add it to any form they'd want.
  - missedthecue 4y ago
    There really isn't anything anyone can preemptively do about someone else committing outright fraud. If that's their intent, all they need to do is photocopy a paper form with your signature on it, and move your signature anywhere they want.
  - ipython 4y ago
    Nothing, obviously. But I didn’t think this was a contest to see who could defraud the customer. Clearly we already established they can charge whatever they like, what more do you want? :)
TheOtherHobbes 4y ago
IANAL, but I suspect it's deceptive if the changes were deliberately hidden and there is no notification of them. For example - if someone agreed a contract, changes are made, and they were pressured to sign without reading the document. If changes are flagged and/or highlighted it would stand a reasonable chance of being valid. Likewise if the patient sent a cover email/letter saying "This is my standard contract." Because these exchanges are bureaucratic, it's quite likely the changes wouldn't be noted - or might possibly be automated. It could be argued that's a failure of diligence by the hospital rather than fraud. And it's also clearly unconscionable to expect patients to sign a literal blank check with an open amount without anything resembling a credible estimate. That's simply unenforceable. All of this underlines why single-payer is the only viable system. Without it a few people get extremely rich with huge financial and social costs to everyone else - which is not freedom, it's forced tribute and subsidy.
Chris2048 4y ago
IF they sign first there's no way to do the switch: the new form would be either missing their signature, or be an (illegal) modification if original terms.

by bshep 4y ago

Peku 4y ago

There is a story is someone doing something similar with their credit card [1]. Not sure how well something like this would fly in the states, but it would be interesting. [1] https://www.nasdaq.com/articles/updated-russian-man-turns-tables-on-bank-changes-fine-print-in-credit-card-agreement-then https://www.nasdaq.com/articles/updated-russian-man-turns-ta...

Vecr 4y ago

It would have to be signed by both sides to count. I've done it before, but you can't just try to sneak things through if they don't sign.

bshep 4y ago
In my experience these forms are only signed by patients, so why are they valid in those cases?
- lisper 4y ago
  The signatures per se don't really matter. What matters in contract law is if there was an actual agreement. The signatures are just evidence that there was an actual agreement. They are neither necessary nor sufficient. This is why verbal agreements can be binding contracts, it's just that these are harder to enforce because it's harder to show that a verbal agreement was actually entered into.
  - DennisP 4y ago
    Well if the patient swapped the form, it would be pretty clear they didn't actually agree to the terms of the original form.
    - cperciva 4y ago
      And if they swap the form in secret in order to trick surgeons into performing an operation which they haven't agreed to pay for, it's pretty clear that they're committing fraud.
      - rowanG077 4y ago
        What do you mean "in secret"? The hospital received the form in full detail. There is nothing secret about it. It's like claiming the ToS are secret because none reads it.
        brazzy 4y ago
        No, it's not at all like that. If someone hands you papers to sign and you give them different papers without telling them so, that is clear intent to deceive, which makes it fraud, or at minimum makes the contract void.
      - jtc331 4y ago
        People keep saying “in secret” but that’d only be true if it happened after it were filed or some such. Giving someone an amended contract isn’t fraud.
        cperciva 4y ago
        Giving someone an amended contract isn't fraud, no. Giving someone an amended contract while making them think it hasn't been amended is a different matter, though.
      - mindslight 4y ago
        Fraud is a strong claim, and it's not clear that there is even an implied contract formed - a contract requires defined consideration. An arbitrary amount conjured out of a hat after service is not well-defined consideration. From my understanding, the medical billing system is so fucked precisely because hospitals bought laws making it so they can arbitrarily bill patients without forming a proper contract (otherwise there would be no way to charge someone who was admitted while unconscious). In the absence of such laws they'd have to fall back to an unjust enrichment claim, under which it would be pretty hard to justify charging someone $25 for an aspirin.
criddell 4y ago
When I was registering as a new patient at a dentist, they gave me the standard form that would let them do things like contact my employer if I didn’t pay my bill on time. I stroked a bunch of that stuff out and initialed it. If it ended up in court and they produced that form, would my amendments mean anything? Is it a contract when only one part signs it?

b3morales 4y ago

The hospital would most likely have a very easy argument that since it's not actually their standard form and you didn't tell them about it, they didn't accept the agreement in any way. And they'd probably try to get you for fraud as well. See also https://xkcd.com/1494/ https://xkcd.com/1494/

kadoban 4y ago
Negotiating the terms of contracts isn't fraud. Neither is refusing their insane terms, no matter how "standard" they want you to believe they are.
- brazzy 4y ago
  Swapping forms in secret is the opposite of negotiating.
  - kadoban 4y ago
    That's true. But then again, "sign this or you're dead" isn't negotiating either. The most honest behavior would probably be to mark additions or changes on the form they give you, if they'll fit.
  - ClumsyPilot 4y ago
    What do you mean in secret? The person explicitly talks about providing the hospital with alternative agreement. It is their responsebility to read everything they sign, just like it is the patient's
    - brazzy 4y ago
      The comment I was referring to: https://news.ycombinator.com/item?id=31461781 https://news.ycombinator.com/item?id=31461781 Verbatim quote: "I doubt anyone would catch it". That is not negotiating, that is fraud. It is absolutely not your responsibility to check for the case that you give someone papers to sign and they give you back something different unless they tell you so.

ipython 4y ago

Can’t do that at our local hospitals. The forms are all computerized and your signature is captured on a small tablet.

est31 4y ago
What protects you from them swapping the forms then? All you gave them was a picture of your signature, they could add it to any form they'd want.
- missedthecue 4y ago
  There really isn't anything anyone can preemptively do about someone else committing outright fraud. If that's their intent, all they need to do is photocopy a paper form with your signature on it, and move your signature anywhere they want.
- ipython 4y ago
  Nothing, obviously. But I didn’t think this was a contest to see who could defraud the customer. Clearly we already established they can charge whatever they like, what more do you want? :)

TheOtherHobbes 4y ago

IANAL, but I suspect it's deceptive if the changes were deliberately hidden and there is no notification of them. For example - if someone agreed a contract, changes are made, and they were pressured to sign without reading the document. If changes are flagged and/or highlighted it would stand a reasonable chance of being valid. Likewise if the patient sent a cover email/letter saying "This is my standard contract." Because these exchanges are bureaucratic, it's quite likely the changes wouldn't be noted - or might possibly be automated. It could be argued that's a failure of diligence by the hospital rather than fraud. And it's also clearly unconscionable to expect patients to sign a literal blank check with an open amount without anything resembling a credible estimate. That's simply unenforceable. All of this underlines why single-payer is the only viable system. Without it a few people get extremely rich with huge financial and social costs to everyone else - which is not freedom, it's forced tribute and subsidy.

Chris2048 4y ago

IF they sign first there's no way to do the switch: the new form would be either missing their signature, or be an (illegal) modification if original terms.