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First, you should hire an attorney.
what kind of specialty
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.
Second, you don't want a ban from the insurance company.
yes i have come to understand that
You should hire a health care attorney.
where can i find a capable one?
If you need help finding one, you can use www.martindale.com or www.lawyers.com.
Both allow you to search be location and practice type.
Also, both have rating systems, so you know you are getting a good lawyer.
such websites rarely explain who is better or worse in terms of dealing with such cases
i wil hire an attorney monday
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.
so i did what she asked, as the only case in my long practice
I understand. Your best argument is that you intended to perform the services and did not intend to defraud the insurance company.
then i was informed that another patient covered by the same insurance company was asked to report all of her treatments since january.
i have never performed such misconduct before
and of course there is no fraud in the second case
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.
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
i thought about writing to the insurance company to refund the extra treatments right away
but am afraid of admitting my wrong-doing
in so doing
I would not volunteer your wrong-doing until you are asked about it.
i have zero intention of keep any extra payments.
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?
You should wait until you receive the investigation letter.
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
Yes, just wait for now.
but in the meantime the wrongdoing eats my mind daily
the anxiety about the second reflects upon my own sense of the ethical situation
the second patient and the first patient
so here are the situations: 1. i should take no action until the investigation letters come
2. if the letters come i should hire a lawyer
my next question is: should i speak to any of these two patients?
i am eager to resolve this, it seems that i should take no action until then
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."
next question: what would be the worst outcome?
fine? imprisonment? suspension of my license?
In theory, criminal prosecution, but that is extremely unlikely.
the amount involved is about 760 usd
what about fine and suspension of licence?
The second worst outcome would be some action on your license. Again, that is very unlikely.
then fine and financial penalty
which i will happily accept
it was my fault anyway
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.
what is the most likely?
in your best judgment how much legal fee should this case incur? just a range would do.
i understand things vary case by case
That is largely a guess, but that's my best estimate.
why does the insurance company would check on the second patient?
is it really related to the first patient?
i understand my own conscience is making the connection, but what is your professional judgment?
In all honesty, it is very difficult to say.
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?
It could be for a number of reasons, possibly related to patient care issues, or an investigation into another provider.
r an investigation into another provider.
do you mean another patient?
Another patient or provider. Sometimes the treatment history of a patient can shed light on another provider.
Again, it is very hard to say.
1. i should not return the payment to the insurance company
2. i should not contact the patient/s
3. i should wait for the insurance company to contact me
4. when the insurance company contacts me i should immediately hire the most effective attorney
5. i should expect to pay a refund and some penalty/fine and be possibly put on a sanction
6. i should expect to pay a 1500 to 5000 usd legal fee to cover the case
did i get all your points?
anything else i should know?
i am prepared to take all my responsibilities
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.
If I can't do anything else for you tonight, please remember to "rate" my answer.
thanks, XXXXX XXXXX
i am yet to learn more about this website
so when i come back how should i find you