Do you owe the doctor money? The problem with not paying the doctor with medical payments funds is that you still owe the debt and the doctor may eventually put you in collections or sue you.
Depending on the communications and representations between you and the insurance company, it is hypothetically possible that there was a technical "fraud" in obtaining the money from insurance company, which is obtaining the money based on false information. On the other hand, if you did not mislead the insurance company in any way, there would be no fraud.
Either way, I'm not sure that your insurance company will care how you use the money. All it is interested in is closing its file after it pays you. Your insurance company does not owe the doctor directly, so is is not likely to come after you for fraud.
It's complicated and you give only bare facts. It depends on how the checks are remitted, and what promises and/or representations you made to obtain the checks
My responses to questions on Avvo are never intended as legal advice and must not be relied upon as legal advice. I give legal advice only in the course of an attorney-client relationship. Exchange of information through Avvo's Questions forum does not establish an attorney-client relationship with me. That relationship is established only by individual consultation and execution of a written agreement for legal services.
A very similar question was asked yesterday, although with less finesse. The answer is it depends. I assume, since you write you're suppose to give it to y our doctor, the insurance company paid you because of services your doctor performed.
You have an agreement with your insurance company, your doctor may have an agreement with your insurance company, and you probably have an agreement with your doctor. Those agreements in total, and probably each of them, obligate payment to your physician by your insurance company and/or you personally.
So, yes. If you cashed a payment from your insurance company intended for your physician without paying your physician for his services, it may very well be fraud – both criminal and civil. They money was not yours and you knew it. Simple solution: pay your physician.
I am licensed in California only and my answers and information on Avvo assume California law. Answers and information provided by me is general information only. It is not legal advice. It must not be relied upon by you. Legal advice must be based on the interplay between specific exact facts and the law. This forum does not allow for the discussion of that interplay. My answer to any specific question would likely be different if that interplay were explored during an attorney-client relationship. Therefore, I provide legal advice during the course of an attorney-client relationship only. The exchange of information through this forum does not establish such a relationship. That relationship is established only by personal and direct consultation with me followed by the execution of a written attorney-client agreement signed by each of us. The communications on this website between us are not privileged or confidential and I assume no duty to you by my participation on Avvo.com. All legal proceedings involve deadlines and time limiting statutes. So that you do not lose any legal rights for failure to timely take appropriate action for your situation, and because I have not provided legal advice in response to your question, you should promptly and personally consult with an attorney for legal advice. Also, see Avvo.com's terms and conditions of use, specifically item 9, incorporated by this reference.
Our Rating is calculated using information the lawyer has included on their profile in addition to the information we collect from state bar associations and other organizations that license legal professionals. Attorneys who claim their profiles and provide Avvo with more information tend to have a higher rating than those who do not.What determines Avvo Rating?Experience & background
Years licensed, work experience, educationLegal community recognition
Peer endorsements, associations, awardsLegal thought leadership
Publications, speaking engagementsDiscipline