My dentists tries to waive off the co-pay. Am afraid this'll be considered a insurance fraud. Isn't it?
Total Comments: 6
Posted: Wed Jan 23, 2013 05:57 am Post Subject:
Why would you think this is fraud? Your dentist is not collecting money to which he is entitled. That's a problem for his accountant not you or your insurance company . . . but it's certainly not fraud.
Posted: Wed Jan 23, 2013 02:14 pm Post Subject:
Waiving co-payments is considered as an insurance fraud. However, the dentist would be committing the fraud and not you. He might be over-billing the insurance company, in which case, he'll be penalized and can even lose his license.
Posted: Thu Jan 24, 2013 04:40 am Post Subject:
Waiving co-payments is considered as an insurance fraud.
WRONG! You don't know what you are talking about. This is completely and utterly a false bit of information.
Fraud requires, among other things, an intent to deceive or gain an advantage through misrepresentation.
Copayments are the portion of a claim that the insurance company does not pay to the physician or other service provider, and is paid by the subscriber to the service provider. That's the provider's compensation. Any physician, technician, hospital, laboratory, radiology group, pharmacy or other service provider is free to waive any portion of his/her income as they may choose, just as they may choose not to bill an insurance company for a treatment rendered to an insured.
Please explain how you came up with the idea that voluntarily giving up one's income is fraud. Doctors, dentists, lawyers, and even life & disability insurance analysts often do this as a matter of their public responsibility.
He might be over-billing the insurance company, in which case, he'll be penalized and can even lose his license.
This, on the other hand, could be an example of insurance fraud, but it is entirely UNRELATED to the concept of copayments.
100 years ago or more, people who had no money to pay the doctor offered chickens, cows, pigs, fresh produce or other craft services in exchange for their treatments. Times were much simpler then, but this would not have ever been considered fraud on anyone's part.
Advice may be cheap, but wrong advice is dangerous.
Posted: Fri Jan 25, 2013 03:09 am Post Subject:
Posted: Mon Feb 04, 2013 05:13 pm Post Subject:
Actually I just found out about this. I believe it can be considered fraud. However it won't be on your part it will be on the physician/ dentists part. There is a federal law regarding this atleast when it comes to writing off deductibles and copayments can be considered fradulent. This is because it is breaking the contract the physician has with the insurance company. The physician has agreed upon a certain amount of a payment for a procedure and if a copayment is waived then the provider is not receiving his full payment. If a copayment / deductible is written off technically you need to be able to prove that the patient has a financial hardship. This is especially true for Medicare and Medicaid patients.
Posted: Mon Feb 04, 2013 06:58 pm Post Subject:
when it comes to writing off deductibles and copayments can be considered fradulent
There is no explicit federal law concerning this. New York and a few states have enacted legislation that seems to make the practice equivalent to filing a false claim. As far as I know, there is no case law on the subject. The "problem" is also defined in terms of "automatically" waiving payments as a matter of routine.
A physician charged with such an offense would probably be able to avoid a conviction if he/she stated that his/her act was "a decision, in the exercise of business judgment, not to pursue the full legal remedies available to collect a debt [and] would not constitute insurance fraud." They simply have to bill it, make one attempt to collect it (sending a bill), and choose not turn it over to collections. It would be a prudent choice not to claim any "bad debt" deductions on their income taxes.
Think of it from a different perspective: A physician submits a bill for orthopedic surgery to fix a broken ankle in the amount of $7,500. Based on "usual, customary, and reasonable fees charged by other surgeons of similar skill and experience," (and a PPO contract) the insurance company pays the physician $77.50. Is that not "criminal"? It's not fraudulent, because the physician signed a contract accepting the payment. And the physician does not deduct the $7422.50 as a bad debt on his income tax return.
There is no certainty that the PPACA will ever improve the payments to physicians and hospitals. Both are in danger of being put out of business, leaving the American public at risk of having to rely only on the government for its health care services . . . as Canadians do . . . and having to wait in lines as long as 6 months to a year to get an MRI for things like a knee injury.
In an era when physicians and insurance companies both are being castigated for charging too much money, and since the PPACA is going to drive insurance companies out of business, physicians in states like Vermont, which wants to have its own single-payer system by 2017, will surely choose to leave the state rather than be forced to accept a state-mandated payment for their services in order for the state to achieve "cost-containment" in health care, it seems ludicrous to me to add this insult to injury.
The PPACA [and the resulting state laws which have had to be enacted] is probably the single biggest disincentive for a person to become a physician in the US. Who in their right mind is going to incur $200,000-$500,000 of education debt to complete medical school, only to face the next 40 years of their life paying off that debt with little hope of saving any money for "retirement". The socialists have won a major battle in their quest to destroy American democracy, one from which America might not recover.
Posted: Wed Jan 23, 2013 05:57 am Post Subject:
Why would you think this is fraud? Your dentist is not collecting money to which he is entitled. That's a problem for his accountant not you or your insurance company . . . but it's certainly not fraud.
Posted: Wed Jan 23, 2013 02:14 pm Post Subject:
Waiving co-payments is considered as an insurance fraud. However, the dentist would be committing the fraud and not you. He might be over-billing the insurance company, in which case, he'll be penalized and can even lose his license.
Posted: Thu Jan 24, 2013 04:40 am Post Subject:
Waiving co-payments is considered as an insurance fraud.
WRONG! You don't know what you are talking about. This is completely and utterly a false bit of information.
Fraud requires, among other things, an intent to deceive or gain an advantage through misrepresentation.
Copayments are the portion of a claim that the insurance company does not pay to the physician or other service provider, and is paid by the subscriber to the service provider. That's the provider's compensation. Any physician, technician, hospital, laboratory, radiology group, pharmacy or other service provider is free to waive any portion of his/her income as they may choose, just as they may choose not to bill an insurance company for a treatment rendered to an insured.
Please explain how you came up with the idea that voluntarily giving up one's income is fraud. Doctors, dentists, lawyers, and even life & disability insurance analysts often do this as a matter of their public responsibility.
He might be over-billing the insurance company, in which case, he'll be penalized and can even lose his license.
This, on the other hand, could be an example of insurance fraud, but it is entirely UNRELATED to the concept of copayments.100 years ago or more, people who had no money to pay the doctor offered chickens, cows, pigs, fresh produce or other craft services in exchange for their treatments. Times were much simpler then, but this would not have ever been considered fraud on anyone's part.
Advice may be cheap, but wrong advice is dangerous.
Posted: Fri Jan 25, 2013 03:09 am Post Subject:
Posted: Mon Feb 04, 2013 05:13 pm Post Subject:
Actually I just found out about this. I believe it can be considered fraud. However it won't be on your part it will be on the physician/ dentists part. There is a federal law regarding this atleast when it comes to writing off deductibles and copayments can be considered fradulent. This is because it is breaking the contract the physician has with the insurance company. The physician has agreed upon a certain amount of a payment for a procedure and if a copayment is waived then the provider is not receiving his full payment. If a copayment / deductible is written off technically you need to be able to prove that the patient has a financial hardship. This is especially true for Medicare and Medicaid patients.
Posted: Mon Feb 04, 2013 06:58 pm Post Subject:
when it comes to writing off deductibles and copayments can be considered fradulent
There is no explicit federal law concerning this. New York and a few states have enacted legislation that seems to make the practice equivalent to filing a false claim. As far as I know, there is no case law on the subject. The "problem" is also defined in terms of "automatically" waiving payments as a matter of routine.
A physician charged with such an offense would probably be able to avoid a conviction if he/she stated that his/her act was "a decision, in the exercise of business judgment, not to pursue the full legal remedies available to collect a debt [and] would not constitute insurance fraud." They simply have to bill it, make one attempt to collect it (sending a bill), and choose not turn it over to collections. It would be a prudent choice not to claim any "bad debt" deductions on their income taxes.
Think of it from a different perspective: A physician submits a bill for orthopedic surgery to fix a broken ankle in the amount of $7,500. Based on "usual, customary, and reasonable fees charged by other surgeons of similar skill and experience," (and a PPO contract) the insurance company pays the physician $77.50. Is that not "criminal"? It's not fraudulent, because the physician signed a contract accepting the payment. And the physician does not deduct the $7422.50 as a bad debt on his income tax return.
There is no certainty that the PPACA will ever improve the payments to physicians and hospitals. Both are in danger of being put out of business, leaving the American public at risk of having to rely only on the government for its health care services . . . as Canadians do . . . and having to wait in lines as long as 6 months to a year to get an MRI for things like a knee injury.
In an era when physicians and insurance companies both are being castigated for charging too much money, and since the PPACA is going to drive insurance companies out of business, physicians in states like Vermont, which wants to have its own single-payer system by 2017, will surely choose to leave the state rather than be forced to accept a state-mandated payment for their services in order for the state to achieve "cost-containment" in health care, it seems ludicrous to me to add this insult to injury.
The PPACA [and the resulting state laws which have had to be enacted] is probably the single biggest disincentive for a person to become a physician in the US. Who in their right mind is going to incur $200,000-$500,000 of education debt to complete medical school, only to face the next 40 years of their life paying off that debt with little hope of saving any money for "retirement". The socialists have won a major battle in their quest to destroy American democracy, one from which America might not recover.
Add your comment