insurance fraud

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PostPosted: Fri May 25, 2007 1:20 pm   Post subject: insurance fraud  

I just quit my job with a chiropractor. He insisted that I bill dates for 2007 for patients that were seen in 2006. The dates were not paid out for 2006 becaue their insurance was exhauste. He wanted to get paid for these 2006 visits. He said "he was not going to eat it". The patient was not seen on that date in 2007. I would not do it because I felt that it was insurance fraud. He said he always did it before. Is there anything I can do about it?


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njphilly
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PostPosted: Sat May 26, 2007 4:11 am   Post subject:   

This really just depends. If the doctor visit was in 2006 I doubt man insurance companies will pay the claim in 2007. Its not necessarily fraud as far as I can tell. Then again, I dont know much about the situation. However, if you have quit your job, then your boss cannot make you do anything. If you feel that it is the wrong thing to do, I would not mess with it. Most health insurance companies dont have much coverage for chiropractic practices anyway. Therefore, these claims will probably not be paid by many insurance company. You have to remember, if the visit was in 2006 the insurance company will most likely look at it as the doctors fault for failure to bill the clients at the proper time. It is absolutely ridiculous to bill a client a year after a service has been done. I suggest you let him "eat it"

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PostPosted: Sat May 26, 2007 6:01 pm   Post subject:   

It is right RandyDarby as per my knowledge insurance company never pay the bill in this situation. But sometime it depends on policy and companies Terms and condition of that particular insurance.



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PostPosted: Mon Jun 04, 2007 5:19 am   Post subject:   

I think the point of the orginal poster was missed. This "Doctor" was trying to have them bill dates of service in 2006 that were denied as dates of service for 2007, since the insured's coverage (number of visits allowed in a year) most likely started over at the beginning of the year. Yes you were correct in not doing this, it is fraud. You now have two options, turn the "Doctor" in, or leave it alone. It is up to you.


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Dasfuk
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PostPosted: Mon Sep 10, 2007 7:07 pm   Post subject: FRAUD YES IT IS !!!!!!  

I understand your question as well, and it most certainly is fraud and he is taking a great risk, with his record, license, and life. You were certainly correct in refusing to do this. There is no other way to look at this other than he is stealing!!



I personally would likely 'turn him in' to the insurance company(s) he was attempting to defraud, as well as the governing body of chiropractors. He is a discredit to his profession. But certainly don't blame you if you don't want to, he will EVENTUALLY get caught. And people wonder why our premiums are so high?



Great job, of keeping your standards high and refusing to do this, (you could've went down with him)!!!

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Lori
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PostPosted: Thu Sep 20, 2007 11:00 pm   Post subject: Insurance Fraud  

Most definitely this is fraud. Misrepresenting dates, amounts of service or type of service, and/or diagnoses codes in any way is not legal. Anyone assisting a physician of any type is also guilty of fraud.


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