If he claimed to do a procedure and didn't, and it was billed to your insurance, this is insurance fraud, thus, report him. Without damages, a lawsuit would be fruitless.
Only 29% Contingency Fee! Phone: 215-510-6755 www.InjuryLawyerPhiladelphia.com
Anyone can sue anyone else for any reason. It does not necessarily mean they will win. If he billed for a service he did not perform, then report him to your insurance company and/or the state medical board.
The answer depends upon what the consequences were of this doctor’s actions. If he or she billed for services that you did not receive, then you should report the doctor to your insurance company because that is fraud.
If the doctor’s actions had more consequences, then you may have other options. For example, we have a case where our client attended a No Fault medical exam at the request of her insurance company. The doctor never examined the client, but filed a report that said he did and also said that she no longer needed treatment. The No Fault insurer used that report to cut off her No Fault benefits. Because she lacked health insurance, the loss of No Fault coverage caused her to postpone medical treatment which allowed her condition to worsen and ultimately require surgery. She is now pursuing a claim for fraud against the doctor with substantial damages because his deceit led to significant medical problems.
If the result of this doctor’s actions was imply pay for services he or she did not perform, then report the doctor to the insurance company. If eh results were more significant damages to you, then I suggest you consult with a local persona injury attorney. The consultation should be free.
The Schlitt Law Firm and Carol L. Schlitt provide answers for informational purposes only. If this answer is helpful, please mark the “helpful” button. If this is the best answer, then please indicate it. Thank you. We are a plaintiffs-only, personal injury and medical malpractice law firm representing clients in the New York metropolitan area. We offer personal services built on the values of communication, education and responsiveness. Please understand that legal advice can only be given by an attorney licensed in your jurisdiction who has a familiarity with the law concerning your question. This answer does not constitute an attorney-client relationship. If you are in the New York metropolitan area, feel free to call us at 1-800-660-1466 or contact our website www.SchlittLaw.com and I will see if we can help you.
If your Dr. fraudulently billed your insurance company, that is insurance fraud. If he fraudulently submitted a claim to Medicare or Medicaid, that is fraud against the federal government and may subject him to a Qui Tam action by you, which could render treble damages, attorney fees and a percentage of the recovery for the government being paid to you. If this is part of a pattern with this doctor, a Qui Tam action may be appropriate and you should consult an attorney in your area who handle such suits. (You may have noticed in the news lately that one of Lance Armstrong's teammates filed a Qui Tam action against him for the money he defrauded from the Postal Service.)
If this information has been helpful, please indicate below.
Mr. Lundeen is licensed to practice law in Florida and Vermont. The response herein is not legal advice and does not create an attorney/client relationship. The response is in the form of legal education and is intended to provide general information about the matter within the question. Oftentimes the question does not include significant and important facts and timelines that, if known, could significantly change the reply and make it unsuitable. Mr. Lundeen strongly advises the questioner to confer with an attorney in your state in order to ensure proper advice is received.
This ans. does not create an attorney/client relationship.
A roundup of the best tips and legal advice.