Do I have a legal case for malpractice or insurance fraud.

Asked over 1 year ago - Burbank, CA

I broke my nose during a sport activity, went to ER and then to a surgeon to repair the broken nose. Paid money upfront to the surgery center per surgeon request and billed my PPO insurance. My insurance covers all medical necessities procedure. On the day of the surgery, during the time I was out, the surgeon decided that he can not do the procedure and he changes the pre-operative paper work. According to his paper work and op report, he has manipulated the bone and sprayed with nasal solutions. The repair of fracture bone never took place. The surgery center has billed and collected the fees plus a fee for his services (all together). As result I have deviated symptoms, have headache and health related issues. Do I have a case.

Attorney answers (4)

  1. Sean Michael Patrick

    Contributor Level 16

    2

    Lawyers agree

    Answered . This doesnt sound like a medical malpractice case although it is difficult to say without reviewing medical records. It does sound like an insurance fraud/fraud case. If the phyisican never performed the surgery he should refund the money that was paid.

    I am licensed in California, therefore, my answers are based on general prinicpals of law or California law, which... more
  2. Paul J Molinaro

    Pro

    Contributor Level 18

    2

    Lawyers agree

    Answered . Many medical malpractice cases come down to whether the doctor made an error which violated the standard of care or made a bad "judgment call" (decision) that was within the boundaries of the standard of care. Repair of a broken nose has a high degree of cosmetics involved but also functional considerations. A good surgeon thinks on his or her feet (they usually operate while standing). This means that he or she should be able to change plans as he or she gets under the skin of the patient. Successfully waging a medical malpractice case against a plastic surgeon or ENT for an imperfect outcome will be difficult. That said, speaking with a medical malpractice attorney is usually free, so there is no reason to fear calling one... maybe one who posts on Avvo?

    As for ripping off insurance companies, should a doctor bill for services NOT performed, the loss would be that of the insurer. I would bet the insurer would love to know about it.

    -Paul

    Paul J. Molinaro, M.D., J.D.
    Attorney at Law, Physician, Broker
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    Paul J. Molinaro, M.D., J.D. ... Attorney at Law, Physician, Broker... Fransen & Molinaro, LLP... 980 Montecito... more
  3. Evan Matthew Oshan

    Contributor Level 11

    3

    Lawyers agree

    Answered . You may want to seek a second opinion from another ENT Doctor Ear Nose and Throat doctor to determine what injuries you might have. Also you may also want to seek counsel from a medical malpractice attorney in your area. Use the Avvo attorney search bar for possible attorneys.

    (206) 335-3880. We retain experts and begin contingency fees at 29%. However, communication through Avvo does... more
  4. Christian K. Lassen II

    Pro

    Contributor Level 20

    3

    Lawyers agree

    Answered . Report this problem your health insurance company, and schedule an appointment with a new doctor to fix.

    Only 29% Contingency Fee! Phone: 215-510-6755 www.InjuryLawyerPhiladelphia.com

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