insurance fraud

[tennisgirl20]

What is the name of your state? Louisiana

My boyfriend has insurance coverage for his 4 yr old daughter. He has joint custody of her but she lives with her mother in a town about 1 1/2 hours away.

Recently on his explanation of benefits he has noticed several claims for his 4 yr old from a chiropractors office. When we looked further into it we realized the daughter had gone every MWF for 2 weeks, my boyfriend picked her up on Saturday for a 4 week visit, and upon dropping her off on a Sunday, she went MWF again. We were told NOTHING about a condition the child might have by the mother and the child showed no symptoms of any type of problem. We found out what clinic she had been to and a close friend of the mother works there.

We are very suspicious and have reported our suspicions to the insurance company. Is there anything else we should do while we are waiting for the insurance company's investigation? Should we question the child and record what she says? If fraud is discovered and the mother is implicated in this, what type of actions will be taken? Does this equal jail time? Can it possibly change who will have custody of the child?

If the suspicions are true we are very frustrated that the mother cannot even be trusted to not abuse the insurance my boyfriend provides for the daughter. Would this be a good thing to take her to court for phsycial custody of the child?

 

[JETX]

Who is 'we'???

If you mean YOU, you have no legal right to get involved in this matter.

If you mean your boyfriend, let him handle it.

 

[tennisgirl20]

Thanks I guess...

If that's the kind of help that I'm going to get then I guess I'm on the wrong site.

I say "we" because he is a man that I love very much and intend to marry one day. I say "we" because this child affects me and my life now and in the future.

I know that I personally have nothing legally to do with this situation, but I CAN find out what avenues my boyfriend can take, I CAN make phone calls for him, I CAN support him and relay advice, I DID speak with the insurance company, I AM allowed to inquire as to the status of the case with them, I AM providing them with information from and about the child to further the case, and I WILL be as involved as much as humanly possible.

If anyone else has any meaningful, CONSTRUCTIVE advice as to what I can ADVISE or SUGGEST that my boyfriend do, please let me know.

Thank you

 

[CIAA]

Just my opinion, but it seems that tops on the list would be concern for the child and preserving an amiable relationship with the mother of the daughter.

It just seems unusual that your boyfriend didn't talk to his ex upfront to find out what was going on. Taking action that may have an adverse affect on the relationship without first making reasonable inquiries to determine what is happening just doesn't seem to be productive for anyone.

 

[I AM ALWAYS LIABLE]

My response:

CIAA, you have to understand how the "Stepparent" mind works. This writer is well on her way to causing future problems that will land her boyfriend in court. A typical Stepparent response is similar to our writer's. She goes behind the other parent's back to make inquiries. Then, when the parent discovers what's going on, things usually "blow up", causing the one, or both, of the parents grief and court costs. The "concern" is not so much about the child, as it is how to butt in and cause problems. Stepparents who butt in really believe they are helping, and will vehemently defend their way of thinking. However, the ulterior motive is always the same - - "What can I do to have the court change custody?"

You see, a stepparent believes, by virtue of their relationship with someone who has a child, that they have some sort of "license" to butt in. They don't. But they still try. It's the same thing as if our writer went to her next door neighbor and tried to tell that mother how to care for her child. Our writer doesn't realize that she has no more rights to do that, than to try to influence the mother of her boyfriend's child.

Stepparents don't understand the phrase, "Butt out."

Oh, our writer won't admit it. She hasn't been a stepparent long enough to know what her actions will do. She will defend her actions - - right up to the point where a judge slaps her boyfriend with a Contempt of Court order.

I see this, and worse, all the time.

IAAL

 

[tennisgirl20]

oh please...

People are so quick to jump to conclusions...

I am not even a stepparent yet, so I'm sure that dwarfs me even more in your opinion. Please do not underestimate my intelligence or my motives by implying that all I'm concerned with is "butting in".

My boyfriend did ask the mother if the child was having back problems. The mother simply said "No". He asked if she had been going to the doctor recently. The mother replied that she had been a few times for a cold.

The insurance company confirmed our feeling that something suspicious was probably going on in the situation due to the relationship between the mother and the woman at the chiropractors office. It was best in their opinion to let them do the investigating. They were also surprised that the claims had not been questioned internally prior to our call.

So far over the course of 2 months, there have been $400 worth of claims filed through this doctor. Not only is this outrageous but it takes away from the benefits my boyfriend can receive from the insurance company.

Really there is very slim of a chance that this would "backfire" in our face. The insurance company is investigating this matter and if questions are asked we can just say they thought the claims were suspicious.

Anyways...I obviously came to the wrong site. All I was interested in was what were the penalties of proven insurance fraud. Would Mom gets jail time, a slap on the wrist, a fine, etc.? And what then does this mean for the child.

 

[CIAA]

My Dear tennisgirl, you had asked for advice for your boyfriend and I didn't jump to conclusions. As I indicated earlier ; honest ,open communication is always the key.

The fact that your boyfriend simply accepted the ex's comment about no treatment for the daughter, and then turning around and reporting her as being a possible insurance fraud may be damaging and harmful for everyone and is the opposite of open communication.

Your desire to hide the fact that you (or he) reported her is not good either.

For goodness' sake, gimme' the phone; I'll find out , and if she's scamming I'm going to talk her into making it right and then I'm going to find out how I can help her.

No wait, I've got a better idea......let's send the daughter's mother to jail, possible do permanant psychological damage to the daughter, have the ex-husband feel forever guilty for not having done it all differently......and they all lived happily ever after.

Goodnight all, and sweet dreams

 

[tammy8]

One thing I learned on this board a long time again that even though WE are a family, I legally can't becoem involved with my stepchildren (except spending my money to provide food, shelter, transporation, etc but that is another post ). I am always sure whenever posting about my family I always make a point of saying MY HUSBAND and not we.

Anyway, if your boyfriend has joint custody and will not speak with the bm about his child, he should contact the dr's office and ask for copies of the medical reports. He will probably have to provide the office with a custody order showing that he has joint LEGAL custody (he does, doesn't he?) because if he does have joint, then he has all rights to review medical files.

As far as the fraud part, if bm is found to be guilty (and it is next to impossible to prove beyond the shadow of a doubt insurance fraud) then she could face jail time (in our state fraud sometimes carries a higher sentence than murder) however in all likeliness, the dr's office will face higher consquences. Probably they will be required to pay back the monies and then be fined.

Your boyfriend MUST open communication with bm because as his daughter gets older, it will get harder and harder if he doesn't now. Just some advice from an old hand at the stepparent game.

 

[tennisgirl20]

Thank you Tammy...

Thank you Tammy for the information...

It's hard to explain the circumstances that are being dealt with in this situation. The biological mother is not a very "upstanding" citizen so to speak and this is just one more incidence of dishonesty on her part (or suspected dishonesty in this case). She's been caught time and again in lie after lie (I won't go into details) and this time it's just too big of an offense. It's the last straw basically. The bio mother and father do communicate, and get along for the most part but he's held his tongue for too long in order to maintain an amicable relationship for the best interest of the child.

This is a major deal in both of our opinions and coming out and accusing her or letting her know we have suspicions would in my opinion do more damage in the relationship than having the insurance company discreetly investigate the matter. If the allegations do prove to be false, and for some reason the medical claims are legitamite, then their is no harm done. The mother never knows we had any doubts about her honesty and the child is not harmed. If they are true however, the insurance company will take whatever measures against her and we will be notified. There is nothing to hold against us.

No one on here has the slightest idea of the personality or tendancies that we are dealing with and I did not ask your personal opinion on how we should approach the matter, what I asked for was information on what the legal consequences were for insurance fraud and how that could affect the child's situation.

I'm sorry but it is not mine or my boyfriend's opinion that the mother should be allowed to get away with this type of action without any consequences.

CIAA - I was not directing my previous comment towards you. You were very kind in your original post. What I did not appreciate was the post that was made after yours, accusing me of being a meddling stepmother.

 

[JETX]

Tenny: You still don't get it. Let me make this VERY simply. You have NO rights in this matter. You are a 3rd wheel in this relationship between your boyfriend AND his ex-wife. And you seem to have focused on the issue of your being called a 'step-mother' when you really aren't. Even that would have given you more rights (very, very limited) then you have now. So, in any post that called you 'step-mother', insert the words 'no one of any importance'. The bottom line would be the same.

As to your claim that you are not a 'meddling stepmother', you are only correct that you are NOT a stepmother. You are a meddling 'person of no rights'. Lets see where you are meddling:

"It's hard to explain the circumstances that are being dealt with in this situation."
What circumstances are YOU dealing with?? You are only a 3rd party with no rights. You are only as involved as YOU think you are.

"The biological mother is not a very "upstanding" citizen so to speak and this is just one more incidence of dishonesty on her part (or suspected dishonesty in this case)."
Is the ethics of the biological mother YOUR version or can you support your claim with some facts of criminal charges. After all, someone could say that YOUR meddling into affairs of others makes you a "not very upstanding citizen". Simply, the issue of ethical behaviour can be in the eye of the viewer.

"She's been caught time and again in lie after lie (I won't go into details) and this time it's just too big of an offense."
Again, are these 'lies' real or just perceived?? Further, how can you say that this 'offense' is too big when you don't even know if one exists??

"It's the last straw basically. The bio mother and father do communicate, and get along for the most part but he's held his tongue for too long in order to maintain an amicable relationship for the best interest of the child."
Oh, this one is good. You admit yourself that HE has been holding his tongue for the good of the child. That is admirable on his part. So, you are admitting that anything you say or do could be detrimental to the relationship or the child!!! In that case, stay out of it!!

"This is a major deal in both of our opinions and coming out and accusing her or letting her know we have suspicions would in my opinion do more damage in the relationship than having the insurance company discreetly investigate the matter."
So, notify the insurance company and let them investigate and handle appropriately. Once you have notified them, never, ever mention it again!!

"If the allegations do prove to be false, and for some reason the medical claims are legitamite, then their is no harm done. The mother never knows we had any doubts about her honesty and the child is not harmed. If they are true however, the insurance company will take whatever measures against her and we will be notified. There is nothing to hold against us."
Accept for the fact that YOU have destroyed the 'amicable relationship' and caused possible harm to the child!!!

"No one on here has the slightest idea of the personality or tendancies that we are dealing with and I did not ask your personal opinion on how we should approach the matter, what I asked for was information on what the legal consequences were for insurance fraud and how that could affect the child's situation."
You have already gotten our answers to this.... you just didn't like them.

"I'm sorry but it is not mine or my boyfriend's opinion that the mother should be allowed to get away with this type of action without any consequences."
What 'action'?? What 'consequences'?? You have simply butted your nose into someone elses business and then brought your dirty bone to this forum to try to have your actions approved. Sorry, but you ARE a meddling 'person of no significance' to the issue.... let your boyfriend handle HIS situation his way. If it isn't of enough concern to him.... then it should be of less concern to you!!

As my sainted grandmother use to say.... "minding your own business is a 24 hour a day job.... and for every hour you spend minding someone elses... you are neglecting your own!!"

 

[tennisgirl20]

Hmmm... Halknet, thank you for opinion. I looked at the website listed at the bottom of your post, so you work at a collections agency for judgements? Congratulations, you sound well qualified.

As for your mindless, idiotic, close minded opinions about MY situation. You're one to preach about minding others business now aren't you?

Thank you ever so much for the suggestion that someone contact the insurance company and let them handle it. If you had read my original post thorougly you would have seen that was exactly what had been done. My QUESTION was if the best route was to just let the insurance company handle it or if there was anything else that needed to be done in the situation. A helpful comment of - Yes, leave it to the insurance company it's the best and least risky course of action for the relationship would have been helpful. Tammy was very helpful with my question concerning what the consequences were if something like this were proven.

As for my being "noone of importance", you can take yourself and your opinions straight to hell. I have a feeling that is where you'll end up anyways. I am of great importance in this situation. I am the partner of a 4 yr olds father. It is my job to make sure she realizes how secure and loved she is when she is in our presense. I love his child with all my heart and I would never wish for anything but the best for her. It has never crossed my mind to do anything out of spite towards her mother or to meddle in their business. The mother and I happen to get along just fine. I do not "meddle" into anyone else's business. I do not deliver messages for my boyfriend, I do not call the mother about her child, I do not inquire any information from her. I AM the one however who encourages my boyfriend's relationshiop with his daughter and with the mother. I remind him of the "bigger picture" and to choose his battles. That is why he has held his tongue for so long. As for her dishonesty, I will not go into details to prove myself to you. Maybe you should mind YOUR own business and leave the advice giving to those who have an inkling of understanding about the topic that they are commenting on.

As I stated before, I realize that I have no rights in this situation, this situation has nothing to do with me personally, but I will not leave my boyfriend high and dry and not support him in these matters. We are both researching this situation and when I was referred to this website I was ecstatic to think that I may receive a qualified legal opinion on insurance fraud and the best action for MY BOYFRIEND (there are ya'll happy?) to take.

I'm not familiar with the membership terms on this site but I sincerely hope you're not out practicing law somewhere...I pity the person who has to listen to your mindless, uninformed, combative comments in person. At least in my situation you are easily quieted with the click of a mouse.

 

[JETX]

You still don't get it.... and can't even keep your own story straight.

In this post, you innocently, "My QUESTION was if the best route was to just let the insurance company handle it or if there was anything else that needed to be done in the situation."

However, by reading your ORIGINAL post, you asked some very pointed questions.....
"We are very suspicious and have reported our suspicions to the insurance company. Is there anything else we should do while we are waiting for the insurance company's investigation? Should we question the child and record what she says? If fraud is discovered and the mother is implicated in this, what type of actions will be taken? Does this equal jail time? Can it possibly change who will have custody of the child?

If the suspicions are true we are very frustrated that the mother cannot even be trusted to not abuse the insurance my boyfriend provides for the daughter. Would this be a good thing to take her to court for phsycial custody of the child?"

YOU clearly have another agenda then the innocent little "what should we do about this??". Your clear intent is to take your concern to the ULTIMATE conclusion.... even to the point of jail time for the mother and your attempts to obtain custody rights!!!

Bottom line... your conduct is contemptible and without merit. You have lied to us on this forum and have now tried to convert your primary reason for posting with some feeble 'Oh, I was just concerned for the insurance company' pap!!! As stated before, legally you are called an interloper (meaning a 3rd party with NO legal standing).

Further, I never said that you were 'no one of importance' in general.. only in this matter.

As IAAL correctly said, you have no more rights to get involved in your boyfriends business then you do if you went to your "next door neighbor and tried to tell that mother how to care for her child."

And finally.... if you had taken the time to understand what I do, you would clearly recognize that I have absolutely NOTHING to do with debt collection. But, then you powers of deduction and reasoning have already been proven to us.... haven't they???

Its been fun.... have a happy day.... and remove your nose from other peoples business!

 

[I AM ALWAYS LIABLE]

My response:

Steve, let me amend my previous caveat to you - -

"Never respond to writers from New Jersey, New York OR potential or actual stepparents."

Stepparents NEVER want to be told what to do. I see this all the time. They try and try and try to justify their actions, and won't believe anything anyone tells them. They just can't fathom the present or future trouble they cause, and feel righteous about their "interferences" - - until a judge throws the book at them.

IAAL

 

[tennisgirl20]

Granted..

Agreed halket.

I'll remove my nose from other people's business when you agree to remove yours from up your own ass.

Oh I lied did I? Maybe I didn't state my question in such concise words but I think that when I repeatedly asked "should we", that is what was implied.

As for my "agenda", yes it does include who has custody of the child. My concern about possible jail time for the mother sparked just that. Who exactly gets the child while the mother sits in jail if she has in fact committed blatant insurance fraud (if that is in fact one of the penalties - that is one question I came on here to find out)?

Please do not assume that I sit around stewing up things to meddle in. I am far more intelligent and have far better things to do than that. But when someone I'm close to asks for my involvement and support in a matter then Yes, I will stick my nose in as far as I have room to. In this case, that rooms ends at the internet searchs, advice and support for my boyfriend. Hopefully that ends your feeble comparison of this matter to my "going next door to tell my neighbor how to raise their child".

 

[I AM ALWAYS LIABLE]

My response:

Your attempts to interfere may, in fact, only end at the Internet - - for now. But, this is how stepparents usually begin their future and continual interferences, and we're trying to "head you off at the pass."

I guess you'll learn from a judge one day.

IAAL