My medical billing company is being sued by a doctor who we no longer bill for. We're a C Corp, the doctor is an LLC
. We couldn't afford an attorney, so the judge ruled us in default. There is a damages hearing scheduled. In order to send claims, a doctor must have an National Provider Identification number assigned by the US Dept of Health & Human Services. It turns out the doctor sold his practice
and its NPI number, kept the LLC, but didn't get a new NPI number. He was submitting claims under a borrowed NPI number. The owner of the borrowed number sent him a "cease & desist" notice on 3/2/09. Using someone else's NPI number is XXXXX fraud. We found this out during discovery. Without an NPI number, we can't legally submit medical claims on the doctor's behalf. The claims we submitted since 03/02/09 are illegal. The judge referred the matter to the US Attorney at my request, and we filed complaints with HHS's OIG as required by law. I am the sole shareholder
of the C Corp. The doctor is the sole shareholder of the LLC.
Will I be able to present this evidence that the doctor is in violation of federal law at the Damages Hearing? Second, I have filed suit Pro Se as an individual and sole shareholder of my company against the doctor as the sole shareholder of his LLC for damages due to his commission of healthcare fraud. Factually, it looks like he's working with a nursing home that accepts payments from Medicare as payment for services in full, he's drawing a salary there as a staff physician AND trying to bill Medicare and Medicaid. THis is called double-dipping under the law and is considered federal healthcare fraud. We're a small company that ended the year with about $3K in the bank. He's suing for $28K claiming that's what he lost in 8 months, but the records I have show he only made $21K in 30 months. So, can I present this evidence at the damages hearing? Can I sue him individually for fraud and money lost as a result of his fraud and failure to perform under the contract