Fabricated Medical Bills

[fleep]

State: Missouri

Issue: My deceased father's dentist has fabricated $50k in dentists fees and submitted them to the estate court. Note that:

* The dentist filed past the deadline and was not a known creditor - he had sent no bills to my father or the estate executor
* We have undisputed records that show my father has already paid ~$50k already. Add in the $50k the dentist claims is still owed and the total comes to ~$100k for work which, at a normal market rate would have cost ~$40k.
* The dentist 'forgot' to credit a $5k check but deposited the check according to our bank records.
* The dentist was prepaid $25k for what appears on the bill as a 'FM restore' but the records show that not all of the teeth had to be replaced. With the assumption that 'FM restore' is Full Mouth restore, we can say that there was less work performed than a 'full mouth restore.'
* The dentist has demonstrably gone back ~10 years in time and added charges that were never submitted to my father (who always paid his bills, including the dentist's bills) on time and were *not* on a patient ledger that my father saved from a few years back.
* When we spoke with the dentist, he stated (I paraphrase) 'It does not matter when I added the charges, I am owed the money and you need to pay it'
* The dentist has already been sanctioned by the states dental board for defrauding another patient.

We've hired a lawyer and $5k later we have what seems (to me, as a layman) to be a relatively weak 'motion to dismiss.' Only the first bullet is even mentioned in the motion, as we are told 'The merits of the case will only be argued if we go forward with litigation.' Of course, litigation will cost more than the $50k the dentist is asking for -- which is, we suspect, how the dentist arrived at the numbers he fabricated.

We strongly suspect a subpoena of the patient ledger would show the dentist added in the charges very recently, but it appears that we have no way to get any of this information in front of the Judge without spending more than what the dentist is asking.

Can a doctor legally make up any amount he wants by making alterations a medical record for work performed over a decade and submit the fabricated charges to the estate court?
Do we have no course of action and no communication channels through which we could request that the judge ask of the dentist "When did you add these charges to the patient's ledger?" --without incurring legal costs that exceed the ask?
What stops anybody from simply crawling the obituaries and submitting 10s of thousands against solvent estates and putting the burden of proof (and legal costs) on the inheritors?

 

[Zigner]

Of course your lawyer only included the first bullet point - it's the easiest one to argue and makes all the other issues moot.

 

[fleep]

Zigner: Thanks for your response. The deadline was mentioned at the in-person filing (both parties were present) and the judge did not seem to care. We have been informed by other lawyers that apparently this 'deadline' can be waived by the judge if he wants to hear the merits, force the case to litigation and (as would be the case here) force the estate into legal fees that would likely exceed the altered medical ledger.

 

[Taxing Matters]

We've hired a lawyer and $5k later we have what seems (to me, as a layman) to be a relatively weak 'motion to dismiss.' Only the first bullet is even mentioned in the motion, as we are told 'The merits of the case will only be argued if we go forward with litigation.'

A motion to dismiss is motion that asks the court to determine that either the complaint fails to state a valid claim or that some law or rule prevents the litigation of the case (like the statute of limitations or filing a proof of claim late). The first bullet point you had — the late filing of a proof of claim — is just the sort of thing that a motion to dismiss is for. It does not require a trial or hearing for the court to weigh the evidence presented by both sides to make a decision. All the other bullet points you mentioned are things that go to whether the doctor's claim that he is owed $50k is correct. And to resolve that, a trial is needed so that you and the dentist can present evidence on the issue of what, if anything, the estate really owes the doctor. That is why your lawyer did not include them.

Can a doctor legally make up any amount he wants by making alterations a medical record for work performed over a decade and submit the fabricated charges to the estate court?

Of course the law does not allow a doctor to defraud the patient and to work a fraud on the court. If you can prove the doctor is committing fraud you can likely get sanctions imposed on the doctor for that, which may include paying the legal fees you had to pay to prove it. Of course, proving fraud is often difficult to do. Your lawyer is the best person to advise you how to proceed in dealing with the dentist.

 

[Zigner]

Zigner: Thanks for your response. The deadline was mentioned at the in-person filing (both parties were present) and the judge did not seem to care. We have been informed by other lawyers that apparently this 'deadline' can be waived by the judge if he wants to hear the merits, force the case to litigation and (as would be the case here) force the estate into legal fees that would likely exceed the altered medical ledger.

Did the judge make a decision yet?

 

[fleep]

Did the judge make a decision yet?

Zigner, not yet. The motion to dismiss will be heard 2 weeks from now.

 

[fleep]

Of course the law does not allow a doctor to defraud the patient and to work a fraud on the court. If you can prove the doctor is committing fraud you can likely get sanctions imposed on the doctor for that, which may include paying the legal fees you had to pay to prove it. Of course, proving fraud is often difficult to do. Your lawyer is the best person to advise you how to proceed in dealing with the dentist.

TaxingMatters: Thanks for the reply. Our lawyer advises that while there is a good chance we could fight the fabricated claims and not owe anything, there is a low chance we could prove fraud - even if we could prove the dentist recently added records to the ledger as far back as 10yrs, this is not necessarily fraud. Fighting the fabricated claims will likely cost very close to the total amount the dentist is claiming and proving fraud significantly more.

It strikes me that we should be able to prove, without incurring $30-50k in legal fees, that that the majority of these costs were added to the ledger years after the work was performed and that the dentist 'forgot to enter' a $5k payment the judge would have to throw this out very easily. Is there any way to request that the judge simply inquire into both of these matters? Does anyone ever represent themselves in these situations?

 

[Zigner]

First - you are represented.
Second - you need to wait for the decision from the judge on the motion to dismiss.

 

[Taxing Matters]

Is there any way to request that the judge simply inquire into both of these matters?

It's not like you can ask the judge and have him or her make an independent inquiry of it. If you contend that that the charges are bogus and were just added recently to scam the estate and the dentist says no, the charges are good, the court has to hear evidence from both sides on that. In short, you need a trial to resolve the dispute. Not all cases take $30k to $50k to litigate to trial, though certainly that can indeed happen.

IDoes anyone ever represent themselves in these situations?

Well, that's a problem in this context. Certainly a person may represent themselves in court. But a person may not represent anyone else in court unless that person is an attorney licensed in Missouri. "An agent or attorney in fact, who is not an attorney at law, cannot file pleadings for another or otherwise practice law. A natural person, not a licensed attorney at law may represent themselves in court, but not others." Risbeck v. Bond, 885 S.W.2d 749, 750 (Mo. Ct. App. 1994). Where the issue arises is that it is the estate that is liable to pay the debts of the decedent. The dentist would bring the action against the estate. The estate is a separate entity from the personal representative of the estate. So, if the personal representative were sued personally for something, say breach of fiduciary duty, the personal representative may represent himself. But when it is the estate that is being sued, the estate needs to be represented by lawyer. It has no way to represent itself.

A few states do provide an exception allowing personal representatives of an estate to represent the estate in probate proceedings (and in Texas the courts are apparently split on this issue) but I have not found anything in my (admittedly quick) search that indicates Missouri allows a personal representative who is not a lawyer to represent the estate in court. You'd want to ask a lawyer in Missouri if any such exception exists allowing the personal representative to represent the estate in probate.

Even if you were allowed to do it, it is not a great idea, especially when the other side has a lawyer. There are a lot of rules and procedures in litigation that you need to know to do it properly. If you don't know all that, you can trip yourself up just on the rules alone. It's like trying to successfully play football when you don't know the rules of the game and the opposing team does know the rules. That's not likely go very well.