Does an insured have a cause of action against medical provider for insurance fraud?

[joedo]

What is the name of your state (only U.S. law)? Michigan

Does an insured person have a cause of action against one of their medical providers who committed insurance fraud, billing for services that they shouldn't have? (In the context of both auto and medical insurance.)

Or, would the only cause of action be for the insurance company (rather than the insured) to file suit against the medical provider? (Or, of course, a prosecutor filing criminal charges.)

EDIT: Assuming there was NO out of pocket expenses from the insured. So, the cause of action would need to be statutory, punitive, etc.

EDIT 2: In case it's relevant, it has to do with having admitted to repeatedly and intentionally billing for services another provider provided.

EDIT 3: No medicare/medicaid, and this occurred before ObamaCare, so I don't believe a Qui Tam case is possible.

 

[Just Blue]

What is the name of your state (only U.S. law)? Michigan

Does an insured person have a cause of action against one of their medical providers who committed insurance fraud, billing for services that they shouldn't have? (In the context of both auto and medical insurance.)

Or, would the only cause of action be for the insurance company (rather than the insured) to file suit against the medical provider? (Or, of course, a prosecutor filing criminal charges.)

EDIT: Assuming there was NO out of pocket expenses from the insured. So, the cause of action would need to be statutory, punitive, etc.

EDIT 2: In case it's relevant, it has to do with having admitted to repeatedly and intentionally billing for services another provider provided.

We don't do homework.

 

[joedo]

We don't do homework.

Not sure if you mean "homework" in the context of a schooling question... Or if you mean "homework" in the looser context of legal research for a personal situation. I haven't been in school for a long time.

 

[Just Blue]

Not sure if you mean "homework" in the context of a schooling question... Or if you mean "homework" in the looser context of legal research for a personal situation. I haven't been in school for a long time.

Your 1st post was in the "3rd party". Seemingly as a homework question. If this situation is YOURS then post it as such.

 

[joedo]

Your 1st post was in the "3rd party". Seemingly as a homework question. If this situation is YOURS then post it as such.

I see. I did genericize my question.

OK.

One of my medical providers has admitted to repeatedly and intentionally billing my auto and medical insurance for services another provider provided.

I'm wondering if I have a cause of action against them for insurance fraud. I don't have any out of pocket expenses (like a co-pay) so I think the only way I would have a cause of action is if there's a Michigan statutory/punitive/private insurance Qui Tam law. I've looked and can't find one, but don't want to miss out on something I'm entitled to. Both my auto and medical insurance were private, don't involve medicare/medicaid, and were before ObamaCare, so I don't believe a typical Qui Tam case is possible.

That leads me to believe the only civil cause of action would be for my insurance companies to directly sue the doctor, or for a prosecutor to file criminal charges... But I'm hoping I've missed something.

 

[cbg]

YOU do not.

Your insurance carrier might.

 

[justalayman]

On top of the fact you have no standing to sue you have never said the provider received any funds from either insurance company.

 

[joedo]

On top of the fact you have no standing to sue you have never said the provider received any funds from either insurance company.

Looks like it's a moot point, but yes the provider received funds from the insurance companies.

 

[Mark Maroon]

One of my medical providers has admitted to repeatedly and intentionally billing my auto and medical insurance for services another provider provided.

If a medical provider bills your insurance for services that were not provided to you by anyone, then that would certainly be fraud committed by the medical provider against your insurance. But I don't know if you would have any cause of action against anyone related to that fraud. Perhaps your insurance company would have a cause of action against that medical provider.

However, if I understand your situation correctly, you are saying that you were in fact provided medical services, but you just don't think the right party billed your insurance. If I understand it correctly your claim is that medical provider "A" provided services to you, but medical provider "B" billed your insurance for those services. I am not sure that there is anything fraudulent or illegal about medical provider "B" billing your insurance for services that were provided to you by medical provider "A". Perhaps A and B have some sort of business/billing relationship.