medical spending account

[pickles1]

In order to gain access to the medical spending account, an individual needed to show that a cost was not paid for by a health insurance plan; thus allowing that individual access for reimbursement.

Consequently, this person submitted a False Bill to the health insurance plan requesting that they NOT PAY THE BILL and provide a Declination of Coverage letter.

Summary:
If an individual submits a False Bill to a Health Insurance Provider, with a REQUEST for DENIAL (since the plan did not cover that item anyway) for the express purpose of trying to obtain a Denial Letter....is this Insurance Fraud?

thanks.

 

[ALawyer]

If the bill submitted was knowingly false, that's fraud -- and even if is not insurance fraud (although it may be), it is probably mail fraud and tax fraud.