health insurance fraud?

[joseph17]

What is the name of your state? What is the name of your state? NJ

On a monthly basis my doctor (Ph.D) had me fill out and sign the patient portion of a blank insurance form, and then he completed his portion (without me seeing it) before submitting to my health insurance company (from employer). A few months ago he called me and said I will be getting a statement for visits which he never saw me, to make up for the 10% co-pay which he did not collect. He said he was doing it for my benefit.

I told him this did not sound right, and requested that he correct the claim form somehow. After writing a letter to him, he did have them cancel potential payment to him for the bogus visits, all except one. He said although he didn't see me on that date, it made up for the very last visit I had, which he did not bill.

My questions are:
1. Can I be held liable in any way by my insurance company because I signed a blank claim form and then my doctor submitted false claim dates which I was not aware of?

2. Do I have any legal remedy besides reporting the apparent fraud to the Psychological Examiner's Board or Insurance Fraud Office? I mean can I sue him for emotional pain and suffering? Here I trusted this professional with my emotional life and then he goes ahead and uses me for his gain.

thanks.
Joe/NJ

 

[cbg]

If you truly had no knowledge that the doctor was committing fraud, no, you won't be held liable. Most doctors do not fill out their portion of the claim form in the patients presence. It's not even remotely unusual for a patient to sign a blank claim form.

But no, you cannnot sue him. Report him, yes. Sue him, no.

 

[joseph17]

NJ
thanks, cbg.
although I've known this Dr. for 17yrs, it still doesn't excuse his fraudulent behavior, and looks like I'll need to make a difficult yet necessary decision.

Joe/NJ

 

[CIAA]

Joseph, I would suggest that you contact the insurance company and report that the "last visit" didn't occur as well.

 

[Beth3]

I agree. Joseph, tell the person at work who administers the company's group health benefits and tell the insurance company. The carrier will want to flag this doctor's future bills (for other claimants) for possible fraudulent activity. It's highly likely you're not the first patient he's falsely billed for and you're not going to be the last.

And by the way, he probably wasn't doing you any favors despits his claim that he was doing so. Many employer's plans have an annual limit (dollar-wise or number of visits) on theraphy visits and related treatment. By falsely billing visits, he may well have been exhausting your annual benefit, thus eliminating your ability to seek further necessary treatment whether from him or somebody reputable. This "doctor" is a dog.

 

[cbg]

Another point - you are up to this point without liability because you have been unaware of the doctor's fraudulent activities. Now that you are aware of it, however, failure to report him *could* end in your being held responsible for aiding him in his attempts. Not terribly likely, but possible.

No pressure, right?

 

[joseph17]

NJ
thanks for each of your advice and support. as a follow-up concern...once I report the alleged fraud, can my Dr. retaliate and try to bill me for co-payments he did not collect over the last 17years?!

thanks
Joe/NJ

 

[cbg]

Technically, yes; according to your insurance contract you owe them. But he'd be shooting himself in the foot - it might be seen as an admission of guilt. Also your state might have a limit on how far back he can bill you, but you'd have to get your state insurance commission to answer that.

I realize that this might not be financially feasible, but probably the best thing you could possibly do would be to voluntarily pay those co-payments now. It would look SO good for you - "As soon as I realized that you were defrauding the insurance company I wanted nothing to do with it - here's your money". You look good and he's left without any possible means of retaliation.

 

[joseph17]

NJ
thanks, cbg. I'll advice of my progress.
Joe/NJ