How JustAnswer Works:

  • Ask an Expert
    Experts are full of valuable knowledge and are ready to help with any question. Credentials confirmed by a Fortune 500 verification firm.
  • Get a Professional Answer
    Via email, text message, or notification as you wait on our site.
    Ask follow up questions if you need to.
  • 100% Satisfaction Guarantee
    Rate the answer you receive.

Ask Chris T., JD Your Own Question

Chris T., JD
Chris T., JD, Attorney
Category: Legal
Satisfied Customers: 3866
Experience:  Experienced in both state and federal court.
45002201
Type Your Legal Question Here...
Chris T., JD is online now
A new question is answered every 9 seconds

I am a trained acupuncturist. A few weeks ago, one of my patients

Customer Question

I am a trained acupuncturist. A few weeks ago, one of my patients asked me to overcharge the insurance company about 600 usd for future visits. I made a mistake by following her request. Now she has reported me to the insurance company. What should I do? Should I write to the insurance company to explain the situation and to pay them back? Should I hire an attorney to deal with this situation? Thanks for your help. Meeya
Submitted: 2 years ago.
Category: Legal
Expert:  Chris T., JD replied 2 years ago.

TexLawyer :

First, you should hire an attorney.

Customer:

what kind of specialty

TexLawyer :

You must treat this situation carefully. There are two potential bad outcomes. First, you have committed the crime of health care fraud. While it may not be a large amount of money, it is still a crime.

TexLawyer :

Second, you don't want a ban from the insurance company.

Customer:

yes i have come to understand that

TexLawyer :

You should hire a health care attorney.

Customer:

where can i find a capable one?

TexLawyer :

If you need help finding one, you can use www.martindale.com or www.lawyers.com.

TexLawyer :

Both allow you to search be location and practice type.

TexLawyer :

Also, both have rating systems, so you know you are getting a good lawyer.

Customer:

such websites rarely explain who is better or worse in terms of dealing with such cases

Customer:

i see

Customer:

i wil hire an attorney monday

Customer:

here is what happened: i made the mistake in may. the patient informed me that she will need further treatments in june but the insurance company refuses to cover the expenses, hence she ask me to charge extra in may so that she can be treated in june.

Customer:

so i did what she asked, as the only case in my long practice

TexLawyer :

I understand. Your best argument is that you intended to perform the services and did not intend to defraud the insurance company.

Customer:

then i was informed that another patient covered by the same insurance company was asked to report all of her treatments since january.

Customer:

i have never performed such misconduct before

Customer:

and of course there is no fraud in the second case

TexLawyer :

While you will clearly be expected to pay the money back, and may even pay some penalties, it will likely avoid being banned. Also, they could put you on pre-approval before you receive future payments.

Customer:

therefore so far i still dont know why the insurance company is checking on the second patient, i am ONLY ASSUMING that it is related to the first patient, though i have no evidence that she did report me to the insurance

Customer:

i thought about writing to the insurance company to refund the extra treatments right away

Customer:

but am afraid of admitting my wrong-doing

Customer:

in so doing

TexLawyer :

I would not volunteer your wrong-doing until you are asked about it.

Customer:

i agree

Customer:

i have zero intention of keep any extra payments.

Customer:

so do you think that i should wait until the investigation letter comes to me to hire a lawyer or should i hire a lawyer now?

TexLawyer :

You should wait until you receive the investigation letter.

Customer:

as i still am not certain why the insurance company is doing the investigation on the second patient, i think that i should just stay put and take no action

TexLawyer :

Yes, just wait for now.

Customer:

but in the meantime the wrongdoing eats my mind daily

Customer:

the anxiety about the second reflects upon my own sense of the ethical situation

Customer:

the second patient and the first patient

Customer:

i meant

Customer:

so here are the situations: 1. i should take no action until the investigation letters come

Customer:

2. if the letters come i should hire a lawyer

Customer:

my next question is: should i speak to any of these two patients?

Customer:

i am eager to resolve this, it seems that i should take no action until then

TexLawyer :

You've got it. No, you should not speak to the patients. You don't want anything construed as if you are tampering with "witnesses."

Customer:

next question: what would be the worst outcome?

Customer:

fine? imprisonment? suspension of my license?

TexLawyer :

In theory, criminal prosecution, but that is extremely unlikely.

Customer:

the amount involved is about 760 usd

Customer:

what about fine and suspension of licence?

TexLawyer :

The second worst outcome would be some action on your license. Again, that is very unlikely.

Customer:

then fine and financial penalty

Customer:

which i will happily accept

Customer:

it was my fault anyway

TexLawyer :

Third, would be a sanction by the insurance company. That is the most likely, but you should be prepared to accept some penalty to avoid a ban from the insurer.

Customer:

what is the most likely?

Customer:

great

Customer:

in your best judgment how much legal fee should this case incur? just a range would do.

Customer:

i understand things vary case by case

TexLawyer :

$1500-5000.

Customer:

great

TexLawyer :

That is largely a guess, but that's my best estimate.

Customer:

why does the insurance company would check on the second patient?

Customer:

is it really related to the first patient?

Customer:

i understand my own conscience is making the connection, but what is your professional judgment?

TexLawyer :

In all honesty, it is very difficult to say.

Customer:

i see

Customer:

when the insurance company checks on a patient's record for the last six months, does it imply a suspicion of the care provider's credibility?

TexLawyer :

It could be for a number of reasons, possibly related to patient care issues, or an investigation into another provider.

Customer:

r an investigation into another provider.

Customer:

do you mean another patient?

TexLawyer :

Another patient or provider. Sometimes the treatment history of a patient can shed light on another provider.

TexLawyer :

Again, it is very hard to say.

Customer:

conclusion:

Customer:

1. i should not return the payment to the insurance company

Customer:

2. i should not contact the patient/s

Customer:

3. i should wait for the insurance company to contact me

Customer:

4. when the insurance company contacts me i should immediately hire the most effective attorney

Customer:

5. i should expect to pay a refund and some penalty/fine and be possibly put on a sanction

Customer:

6. i should expect to pay a 1500 to 5000 usd legal fee to cover the case

Customer:

did i get all your points?

TexLawyer :

That's correct.

Customer:

anything else i should know?

Customer:

i am prepared to take all my responsibilities

TexLawyer :

Not that I can think of. If you get more information and have questions in the future, you can direct them to me by posting a question with "this question is for TexLawyer" in the title.

TexLawyer :

If I can't do anything else for you tonight, please remember to "rate" my answer.

Customer:

thanks, XXXXX XXXXX

Customer:

i am yet to learn more about this website

Customer:

so when i come back how should i find you

Chris T., JD, Attorney
Category: Legal
Satisfied Customers: 3866
Experience: Experienced in both state and federal court.
Chris T., JD and 11 other Legal Specialists are ready to help you
Expert:  Chris T., JD replied 2 years ago.
You can access your chat through your profile. If you would like to post a question for me in the future, you should post a question with "this question is for TexLawyer" in the title.

JustAnswer in the News:

 
 
 
Ask-a-doc Web sites: If you've got a quick question, you can try to get an answer from sites that say they have various specialists on hand to give quick answers... Justanswer.com.
JustAnswer.com...has seen a spike since October in legal questions from readers about layoffs, unemployment and severance.
Web sites like justanswer.com/legal
...leave nothing to chance.
Traffic on JustAnswer rose 14 percent...and had nearly 400,000 page views in 30 days...inquiries related to stress, high blood pressure, drinking and heart pain jumped 33 percent.
Tory Johnson, GMA Workplace Contributor, discusses work-from-home jobs, such as JustAnswer in which verified Experts answer people’s questions.
I will tell you that...the things you have to go through to be an Expert are quite rigorous.
 
 
 

What Customers are Saying:

 
 
 
  • Mr. Kaplun clearly had an exceptional understanding of the issue and was able to explain it concisely. I would recommend JustAnswer to anyone. Great service that lives up to its promises! Gary B. Edmond, OK
< Last | Next >
  • Mr. Kaplun clearly had an exceptional understanding of the issue and was able to explain it concisely. I would recommend JustAnswer to anyone. Great service that lives up to its promises! Gary B. Edmond, OK
  • My Expert was fast and seemed to have the answer to my taser question at the tips of her fingers. Communication was excellent. I left feeling confident in her answer. Eric Redwood City, CA
  • I am very pleased with JustAnswer as a place to go for divorce or criminal law knowledge and insight. Michael Wichita, KS
  • PaulMJD helped me with questions I had regarding an urgent legal matter. His answers were excellent. Three H. Houston, TX
  • Anne was extremely helpful. Her information put me in the right direction for action that kept me legal, possible saving me a ton of money in the future. Thank you again, Anne!! Elaine Atlanta, GA
  • It worked great. I had the facts and I presented them to my ex-landlord and she folded and returned my deposit. The 50 bucks I spent with you solved my problem. Tony Apopka, FL
  • Not only did he answer my Michigan divorce question but was also able to help me out with it, too. I have since won my legal case on this matter and thank you so much for it. Lee Michigan
 
 
 

Meet The Experts:

 
 
 
  • Tina

    Lawyer

    Satisfied Customers:

    8436
    JD, BBA Over 25 years legal and business experience.
< Last | Next >
  • http://ww2.justanswer.com/uploads/MU/multistatelaw/2011-11-27_173951_Tinaglamourshotworkglow102011.64x64.jpg Tina's Avatar

    Tina

    Lawyer

    Satisfied Customers:

    8436
    JD, BBA Over 25 years legal and business experience.
  • http://ww2.justanswer.com/uploads/RA/ratioscripta/2012-6-13_2955_foto3.64x64.jpg Ely's Avatar

    Ely

    Counselor at Law

    Satisfied Customers:

    19941
    Private practice with focus on family, criminal, PI, consumer protection, and business consultation.
  • http://ww2.justanswer.com/uploads/FL/FLAandNYLawyer/2012-1-27_14349_3Fotolia25855429M.64x64.jpg FiveStarLaw's Avatar

    FiveStarLaw

    Attorney

    Satisfied Customers:

    8189
    25 years of experience helping people like you.
  • http://ww2.justanswer.com/uploads/jespoag/2008-12-17_222355_jessepic.jpg JPEsq's Avatar

    JPEsq

    Attorney

    Satisfied Customers:

    2132
    Experience as general attorney, in house counsel, SSDI, Family Law attorney, and law professor
  • http://ww2.justanswer.com/uploads/gsenmartin/2008-04-22_214950_me1.jpg Guillermo J. Senmartin, Esq.'s Avatar

    Guillermo J. Senmartin, Esq.

    Attorney

    Satisfied Customers:

    110
    7+ years of experience handling various legal matters.
  • http://ww2.justanswer.com/uploads/PA/PaulmoJD/2013-10-10_195858_JAImage.64x64.jpg Law Educator, Esq.'s Avatar

    Law Educator, Esq.

    Attorney

    Satisfied Customers:

    31621
    JA Mentor -Attorney Labor/employment, corporate, sports law, admiralty/maritime and civil rights law
  • http://ww2.justanswer.com/uploads/dkaplun/2009-05-17_173121_headshot_1_2.jpg Dimitry K., Esq.'s Avatar

    Dimitry K., Esq.

    Attorney

    Satisfied Customers:

    15975
    Multiple jurisdictions, specialize in business/contract disputes, estate creation and administration.
 
 
 
Chat Now With A Lawyer
Chris T., JD
Chris T., JD
Lawyer
3866 Satisfied Customers
Experienced in both state and federal court.