accused of trying to commit fraud

[Dental Abuse]

What is the name of your state (only U.S. law)? California
I guess I should start by saying my sister suffers from Schizophrenia and Depression and is on disability. She went to the dentist and was treated very poorly by the Administrative Staff and accused of trying to commit a crime of fraud, not sure why. We have a plan; other than the state insurance, for dental and it pays cash benefits to be used as we sit fit and the benefits are predetermined and paid regardless of any other insurance we have. The Manager's behavior and communication with her has been inexcusable and I have tried filing a complaint with their corporate office but the supervisor does not seem to care of his behavior at all. She has given me the run-a-round by saying she will meet with me on a certain day but do not, giving me fax numbers that do not work, and refusing to answer or return my calls. I do not know what else to do and I was wondering if we could file a small claims suit and maybe they will care then. I am trying to keep it short; but if you need details, I will give them. I would greatly appreciate any advice.
Thanks

 

[justalayman]

file a suit for what?

If you do not like how your sister was treated, find treatment elsewhere.

 

[Zigner]

What is the name of your state (only U.S. law)? California
I guess I should start by saying my sister suffers from Schizophrenia and Depression and is on disability. She went to the dentist and was treated very poorly by the Administrative Staff and accused of trying to commit a crime of fraud, not sure why. We have a plan; other than the state insurance, for dental and it pays cash benefits to be used as we sit fit and the benefits are predetermined and paid regardless of any other insurance we have. The Manager's behavior and communication with her has been inexcusable and I have tried filing a complaint with their corporate office but the supervisor does not seem to care of his behavior at all. She has given me the run-a-round by saying she will meet with me on a certain day but do not, giving me fax numbers that do not work, and refusing to answer or return my calls. I do not know what else to do and I was wondering if we could file a small claims suit and maybe they will care then. I am trying to keep it short; but if you need details, I will give them. I would greatly appreciate any advice.
Thanks

File a claim for what? First, this isn't your problem so you have no standing to file anything. Second, based on what you have presented, there is nothing actionable here anyway. Of course they are giving you the run-around. Well, more accurately, they are brushing you off. Some places would simply have told you to pound sand.

 

[Just Blue]

What is the name of your state (only U.S. law)? California
I guess I should start by saying my sister suffers from Schizophrenia and Depression and is on disability. She went to the dentist and was treated very poorly by the Administrative Staff and accused of trying to commit a crime of fraud, not sure why. We have a plan; other than the state insurance, for dental and it pays cash benefits to be used as we sit fit and the benefits are predetermined and paid regardless of any other insurance we have. The Manager's behavior and communication with her has been inexcusable and I have tried filing a complaint with their corporate office but the supervisor does not seem to care of his behavior at all. She has given me the run-a-round by saying she will meet with me on a certain day but do not, giving me fax numbers that do not work, and refusing to answer or return my calls. I do not know what else to do and I was wondering if we could file a small claims suit and maybe they will care then. I am trying to keep it short; but if you need details, I will give them. I would greatly appreciate any advice.
Thanks

Did you PERSONALLY witness the "poor" behavior by the staff?

 

[LdiJ]

What is the name of your state (only U.S. law)? California
I guess I should start by saying my sister suffers from Schizophrenia and Depression and is on disability. She went to the dentist and was treated very poorly by the Administrative Staff and accused of trying to commit a crime of fraud, not sure why. We have a plan; other than the state insurance, for dental and it pays cash benefits to be used as we sit fit and the benefits are predetermined and paid regardless of any other insurance we have. The Manager's behavior and communication with her has been inexcusable and I have tried filing a complaint with their corporate office but the supervisor does not seem to care of his behavior at all. She has given me the run-a-round by saying she will meet with me on a certain day but do not, giving me fax numbers that do not work, and refusing to answer or return my calls. I do not know what else to do and I was wondering if we could file a small claims suit and maybe they will care then. I am trying to keep it short; but if you need details, I will give them. I would greatly appreciate any advice.
Thanks

Are you your sister's rep payee or financial/legal guardian? Is the dispute over payment? Its very unclear here because you are complaining of poor treatment by the administrative staff...but you mention insurance.

Could you please be clearer about what the actual problem is and ask more specific questions?

 

[Dental Abuse]

Are you your sister's rep payee or financial/legal guardian? Is the dispute over payment? Its very unclear here because you are complaining of poor treatment by the administrative staff...but you mention insurance.

Could you please be clearer about what the actual problem is and ask more specific questions?

Yes... and I do not think that he should be able to refuse to give her documentation to file her claim with her other insurance because he feels she is trying to commit fraud; such as her ex-rays and the bill for $0.00 (which she no longer needs because I am getting it from her primary insurer), but this man's unprofessional and nasty behavior towards her and while interacting with her is unacceptable. I know the people on here do not care about her mental state, but I do. She has tried to commit suicide 2 times in the past and this man's behavior and accusing her of trying to commit a crime has her very depressed because she do not understand how she is doing wrong; or even, what she is doing wrong. I have tried to find out who she is committing fraud against or if she is committing fraud by contacting Medi-Cal, Medicare, Kaiser (both her Medi-Cal and Medicare is assigned to them); and of course, DeltaCare USA. They have all said that she is not committing fraud against any of them; and as long as Physician's Mutual know of her other insurance and she is responsible and submitting a bill of $0.00, it does not sound like she is committing fraud against Physicians Mutual, but I needed to contact them to be sure.
Thanks

 

[Silverplum]

Yes... and I do not think that he should be able to refuse to give her documentation to file her claim with her other insurance because he feels she is trying to commit fraud; such as her ex-rays and the bill for $0.00 (which she no longer needs because I am getting it from her primary insurer), but this man's unprofessional and nasty behavior towards her and while interacting with her is unacceptable. I know the people on here do not care about her mental state, but I do. She has tried to commit suicide 2 times in the past and this man's behavior and accusing her of trying to commit a crime has her very depressed because she do not understand how she is doing wrong; or even, what she is doing wrong. I have tried to find out who she is committing fraud against or if she is committing fraud by contacting Medi-Cal, Medicare, Kaiser (both her Medi-Cal and Medicare is assigned to them); and of course, DeltaCare USA. They have all said that she is not committing fraud against any of them; and as long as Physician's Mutual know of her other insurance and she is responsible and submitting a bill of $0.00, it does not sound like she is committing fraud against Physicians Mutual, but I needed to contact them to be sure.
Thanks

You can't force someone to be professional in their manner, or nice, or friendly, or generous with his/her time to explain bills or other things. That's just a fact of life. And no, you cannot sue someone for that.

 

[Dental Abuse]

File a claim for what? First, this isn't your problem so you have no standing to file anything. Second, based on what you have presented, there is nothing actionable here anyway. Of course they are giving you the run-around. Well, more accurately, they are brushing you off. Some places would simply have told you to pound sand.

I have worked with the public a long time; and No, some places would NOT tell me to go pound the sand just for filing a complaint of misconduct by their Administrative Staff because MOST places would want to know of how their patients are being treated because the PATIENTS are how they make their money.

 

[Dental Abuse]

You can't force someone to be professional in their manner, or nice, or friendly, or generous with his/her time to explain bills or other things. That's just a fact of life. And no, you cannot sue someone for that.

1st of all; NO ONE, asked of his time to explain bills or other things.
2nd; No one should have to force any employee; of any company, to be professional in their manner, or nice, or friendly, or generous because when you work with the public; in any line of work, it is a requirement.
3rd; I have worked with the public since I was 16 years old; and I know for a fact, he does NOT get paid to conduct business in the manner in which he has, disrespect, insult, and humiliate their patients the way he has my sister, and be so rude, unprofessional, and unwilling to communicate as he has been with me. I was looking for a way to make his supervisor address his behavior, but I will keep doing what I am doing; and eventually, I will reach someone who cares about the way this man treats their patients.

 

[Proserpina]

1st of all; NO ONE, asked of his time to explain bills or other things.
2nd; No one should have to force any employee; of any company, to be professional in their manner, or nice, or friendly, or generous because when you work with the public; in any line of work, it is a requirement.
3rd; I have worked with the public since I was 16 years old; and I know for a fact, he does NOT get paid to conduct business in the manner in which he has, disrespect, insult, and humiliate their patients the way he has my sister, and be so rude, unprofessional, and unwilling to communicate as he has been with me. I was looking for a way to make his supervisor address his behavior, but I will keep doing what I am doing; and eventually, I will reach someone who cares about the way this man treats their patients.

That's not going to happen.

What makes you think he or his supervisor have any obligation to even speak with you? You are owed nothing.

And answer the question - were YOU present?

You expect him to discuss with you, matters pertaining to one of his patients? Why is that?

 

[Just Blue]

That's not going to happen.

What makes you think he or his supervisor have any obligation to even speak with you? You are owed nothing.

And answer the question - were YOU present?

You expect him to discuss with you, matters pertaining to one of his patients? Why is that?

Thanks Pro ...I was going to ask OP to answer that question I asked 15 hours ago.

 

[LdiJ]

Thanks Pro ...I was going to ask OP to answer that question I asked 15 hours ago.

He hasn't answered the questions I asked either. He is doing a very poor job of explaining the situation and then ignores specific questions.

 

[Just Blue]

He hasn't answered the questions I asked either. He is doing a very poor job of explaining the situation and then ignores specific questions.

Yup!! One has to wonder why s/he would do that....

 

[davew128]

Probably still suffering novocaine numbness....

 

[single317dad]

Under most needs-based state insurance programs, it's illegal to double-claim. The other policy is an asset which should be used to pay the medical bill, and the remainder submitted to the state insurance. I'm not familiar enough with the Kaiser program to speak on that specifically, but Medicaid by and large insists on being the second/last payer after all other insurance is exhausted. Failure to follow this procedure can indeed be fraud, can cost the beneficiary their benefits, and can cause the provider to be removed from the insurance program.

Given all that, even if it's all accurate (not necessarily true given my lack of knowledge of CA), there's no reason for staff to behave unprofessionally. In my experience, most accusations of treatment staff's "unprofessional or abusive behavior" amount to a patient or their representative not getting what they want and throwing a fit, but that's neither here nor there.