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Loren
Loren, Attorney
Category: Business Law
Satisfied Customers: 29094
Experience:  30 years experience representing clients .
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Greetings, My daughter is enrolled in Applied Behavior

Customer Question

Greetings,
My daughter is enrolled in Applied Behavior Analysis. The owners of the facility she currently attends claim that she has Autism in order to charge the insurance more money. She actually carries a diganosis of Rett Syndrome, which, although the symptoms are similar, is a completely different disorder. It seems to me like they are scamming, is there any legal consequence to this action?
Thank you,
Matthew
Submitted: 11 months ago.
Category: Business Law
Expert:  Loren replied 11 months ago.

Good afternoon. I am Loren, a licensed attorney, and I look forward to assisting you.

Expert:  Loren replied 11 months ago.

Have they made a diagnosis which they can support?

Expert:  Loren replied 11 months ago.

Are you online with me?

Customer: replied 11 months ago.

My daughter was diagnosed with autism a couple of years ago because they were unfamiliar with Rett Syndrome. As of Febrary, genetic testing was done and a diagnosis of Rett Syndrome was confirmed and autism was removed. At that time her ABA therapy decided to keep the documentation of autism active;however, they unofficially changed her treatment plan to be geared toward Rett Syndrome without putting it on paper.

Expert:  Loren replied 11 months ago.

It is really only a problem if there is an intent to defraud. In other words, if there is any medical support, using current diagnostic standards and protocol for a finding of autism then it is not illegal or improper for the faciliry to include it in her treatment.

However, the autism diagnosis has been withdrawn then it is, potentially, a basis for insurance fraud to continue billing for treatment based upon the withdrawn diagnosis and the billing should be updated.

Expert:  Loren replied 11 months ago.

Did you have further questions? Have I answered your question?

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