For what a hospital patient is charged for a tablet of Tylenol, the patient could buy a whole box of Tylenol at a drug store.

For what the patient is charged for a night in a hospital bed, the patient could spent two weeks in a first-class hotel.

And for what at least one CEO of a large, national health insurance, William McGuire of United Health, earned in one year, a community could build six public schools at $20 million each.

To Roy J. Meidinger, those are the symptoms of a sick health care system. And he thinks he has the cure.

The high cost of health care in America is due to the way hospitals charge all patients the same price, but then grant secret discounts to the insurance companies that are responsible for paying those bills, according to Meidinger, a health cost reform activist from Fort Myers.

The discounts are granted under secret contracts that insurance companies negotiate with the hospitals. They call for the companies to pay as little as 10 percent of the charges billed to the patient. On average, the discounts knock off 50 percent of the hospital's charges, Meidinger says.

In exchange for the discounts, the insurance companies limit the choices of their patients. If they choose to go to hospitals "off net," they're charged hefty penalties.

In litigation he has filed against hospitals nationwide over the past 12 years, Meidinger has argued the secret contracts amount to kickbacks, price discrimination and Medicare and Medicaid fraud.

Now, in his latest litigation, he claims they result in tax evasion.

In the past, his litigation has been dismissed by various federal courts.

Soon, however, Meidinger believes he'll have the Internal Revenue Service as an ally.

He cites a Sept. 10 directive issued by John Risacher, an IRS national director over the the retailers, food, pharmaceuticals and health care industries.

Risacher, in the memo, calls the way hospitals account for the secret contracts a "compliance issue."

Meidinger, a retired AT&T-trained systems analyst, said he believes he may have triggered the memo. In 2006, he tried to get the IRS and the Department of Justice to open a criminal investigation into the billing systems of 2,786 hospitals nationwide. He furnished the IRS numerous documents to substantiate his claims.

But, Risacher never states in the memo that the contracts are unlawful. His memo merely provides a guide for examiners to evaluate whether the accounting methods are proper, if the contracts are "legally enforceable."

Meidinger, however, believes the directive will lead auditors to examine the actual contracts for the first time ever. To date, they have been considered confidential. In fact, they are exempt from Florida's public records laws.

His suit has no chance of success, according to Jack Klingensmith, attorney for Lee Memorial. Calling his claim "ridiculous," Klingensmith pointed out that Meidinger has had his four previous cases dismissed.

Insurance companies negotiate hefty discounts because the companies can send large numbers of their insured to the particular hospital, Klingensmith confirmed.

That helps health care consumers, because they can hire "the purchasing power" of their insurance company, he argued.

Reforming billing practices won't address the biggest problem -- covering the costs of patients who pay little or nothing, said Rich Rasmussen, spokesman for the Florida Hospital Association.

Florida's hospitals pick up the tab for $2 billion per year in unfunded care, he said.

"The bigger issue is how to we deal with over 50 million people who are uninsured in America," he said.

Jim Alexander, technical director for the Health Care Financial Management Association, said Meidinger's claims should target the accounting industry, not the hospital or insurance industries.

"The hospital industry's auditors have basically dictated how these things are handled," Alexander pointed out. "He's trying to change accounting practices, and that's unbelievable."

Alexander said hospitals first began writing off mandatory discounts to Medicare and Medicaid as "contractual allowances" after those programs were created some 37 years ago.

Since then, the contractual allowances were applied to the secret discounts to insurance companies.

The hospital industry isn't opposed to reforming its billing system.

"The simpler we could make it, the better off we'd be," Alexander said. "But, it's also like trying to simplify the IRS tax code. It's a daunting task."

The fact that there's a big difference between the prices charged and the amounts collected has its roots in the days when insurance companies negotiated to pay a percentage of the prices, said Tom Rice, CEO of Fawcett Memorial Hospital in Port Charlotte, confirmed that hospitals charge all patients the same price. That gave hospitals an incentive to raise prices, he said.

Now, however, the federal government, through its Medicare and Medicaid programs, has become the driving force. The government is working to reform the health care system by bringing more "transparency" to pricing and clinical performance, he said.

"I think (Meidinger) is out of step with where Medicare is going," Rice said.

Once the IRS examines the secret contracts, Meidinger is convinced the IRS will come to the same conclusion he's reached -- that the contracts amount to kickbacks in exchange for brokering patients.

That would make them unlawful and unenforceable.

If the government reaches that conclusion, it would forbid the hospitals from writing off the kickbacks as deductions from revenues, he theorizes. Instead, the discounts should be considered a "forgiveness of debt," which is not tax deductible, according to Meidinger.

He cites a fair-trade law that requires all patients to pay the same price for the same service regardless of whether they have insurance or not.

"It is not a 'discount,'" Meidinger said. "Get the word 'discount' out of your head. It's a kickback."

Meidinger's goal is try to recover trillions of dollars in damages from the hospitals that use the system.

But, his suit currently targets only Lee Memorial Health System in Fort Myers, which has written off some $875 million in contractual discounts to insurance companies over the past seven years.

Filed as a "qui tam" lawsuit, the claim seeks to collect triple the damages. Such a penalty, if awarded, would be astronomical.

"I recognize I cannot destroy the health industry," Meidinger said. "But, I will not allow a single person or business to be taken advantage of by thieves. The fraud has got to stop."

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