False Claim Advice

[joseph17]

- have been seeing a doctor for over 10 years, who didn't charge me any co-pay , as we verbally agreed that he would accept my insurance payment as payment in full.

- he just told me that he sent in a claim form using dates he never saw me, so that he could re-coup the co-payments which he never received from me! he said he now wants to charge the co-payment in future visits.

- i asked if he could withdraw his claim, but he said it may be difficult and raise some suspician. i've always respected this doctor, but now I have some doubts, as I believe he has used very poor judgement.

- i was just going to tell him that unless he can withdraw his claim (or send the check back when he gets it), that I don't feel comfortable continuing to see him. (i had to sign a blank claim form before he filled out the form with the false dates). another thought was to see if he could see me for the same number of visits which he filed (falsely), and not send in a claim for these visits (but i could pay the co-pay).

- i don't want to get into any legal trouble if there is some type of audit and they find out there was potential fraud, and I don't want to be held responsible for the co-payments over the last 10years +!

any suggestions on how to resolve this matter?
thanks

Joe/NJ

 

[Beth3]

Your doctor is absolutely engaging in insurance fraud by filing a claim with your group health carrier for services not rendered.

If he chose to "forgive" any monies you would otherwise have owed him, such as a co-pay, that's between the two of you and perfectly legal. But billing an insurance carrier for services not rendered is flat-out fraud. Since you're aware of it, this *could* have some consequences for you if you do nothing. If this is an insurance plan through your employer and they become aware of what's taken place, they could easily terminate you for dishonesty for not informing them or the carrier what is taking place.

My advice to you is to tell your employer/carrier immediately AND look for another doctor. The one you have is a crook.

 

[joseph17]

thank you Beth. I knew what he did, didn't seem right, but now I know how wrong it really was and how severe the consequences could be!

Joe/NJ