CISGuy

Insurance Fraud & Collection Agencies

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Anyone know of any good articles, outside of the first 10 pages of an internet search, on medical billing fraud. I have some collections from a few years ago. These collections might be from legitimate bills. However, the reason they weren't paid is likely due to some insurance fraud on the part of a former doctor of mine.

 

The fraud looks like this: He reported charges WAAAY higher to my insurance agency than me, to the tune of $1400 per 15 minute session. That quickly drained my yearly maximums. However, when I went in it was the usual co-pay of $20. There was never a mention of an outstanding balance, or a request for payment from me. There was also never any collections on his part. I suddenly got notice before one appointment that he was no longer with that clinic. I went back to see another doctor and mentioned the discrepancies and he basically said, "He was involved in some funny stuff and I'm part of the reason he's no longer here."

 

So, after his obscene charges other medical services I had ended up in default. I'm would just like to see if I have any legal protections...

 

Thanks.

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You have the same "legal protections" as anyone else allegedly obligated to pay a debt. 

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The practice you are referring to in known as upcoding. Upcoding occurs when a provider intentionally uses a higher-paying code on the claim form for a patient to fraudulently reflect the use of a more expensive procedure or device than was actually used or was necessary.

 

It is mostly used with medicaid and medicare, but has been used with private insurance companies. I am surprised your insurance did not file a suit.

 

You should see an attorney over this, the laws on insurance fraud are too much for a pro se to handle.

 

Now if you had a government provided insurance, it falls under the False Claims Act, also known as the Lincoln Law.

 

Google upcoding and unbundling

Also research the False Claims Act. It has a qui tam provision.

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