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Ely
Ely, Counselor at Law
Category: Legal
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Experience:  Private practice with focus on family, criminal, PI, consumer protection, and business consultation.
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Hello. I have been doing medical billing for a doctor since

Customer Question

Hello. I have been doing medical billing for a doctor since January 2011. The doctor was initially under contract with a business partner & myself with a monthly contract min. of $2000 per month or 8% (whichever is higher).

On or around May 2012, my business partner and I had a fallout as a result of the doctor's negligence to pay his monthly contracted rate on a timely basis . Ultimately, my business partner and I parted. I opened up my own company at that time & continued to service the doctor's acct. The doctor agreed.

We never entered into a new contract listing just him and I; however, we went into a verbal agreement and kept the same terms we initially agreed upon: $2,000 or 8% (whichever is great) monthly minimum contract rate.

The doctor continued to make payments on a monthly basis (sometimes bi or tri monthly). Payments varied from $2,000-3000. The addtnl $500 or $1000 that was sometimes paid exceeding the monthly min was to apply it towards the past due balance that resulted due to his untimely monthly pymts.

Little-by-little the doctor was paying off his debt owed to me. However, he would constantly complain that the ins companies were not paying him what they "should" be paying him & began to accuse me of not servicing his account correctly, not collecting on pt balances, etc.

The doctor & I had "various" meetings wherein I indicated to him that he could not bill for weight management related office visits, charge the pt a monthly fee ranging anywhere from $500 to $800 per month (plus the cost of weight management pills), BILL the patient's ins. co. as a medical office visit, and then ALSO bill the pt for their co-payment/ded/co-ins/etc. I addressed this matter to him on several occasions & he kept instructing his office staff to submit the charges to me so that I may bill. There was not any way that I could foresee who was really a weight management pt or medical pt. I would bill the information provided by the doctor.

Once I received the EOB from the ins company, I would post the payment (if paid) & then place an alert within the software system so that the doctor's front desk staff could collect the past due balance from the patients. I would repeatedly follow up on a daily basis and was constantly being advised by staff to waive the patient co-payments, etc. as it was a weight management related visit.

I addressed this situation many(!) times with the doctor, along with the fact that he was billing ins companies merely because a pt would call in with a med ques or he would refill a prescript. over the phone. Then there was all the Medicaid claims that he would bill simply because he wasn't satisfied with the amount of pts seen on a given day....he would request that staff pull out 10-15 Medicaid patient charts & bill the ins co as if he has seen the patient in the office. (His front desk receptionist notified my about the fraudulent Medicaid billing).

After months of dealing with his tactics, his constant complaining that he does not have money, now he began to ask me for an a/r report outlining how much he has made in the months of April/May 2013. I provided him with that info on June 1, 2013.

Afterwards, he started to bicker & complain that he also wanted his aging report. That automatically prompted up a red flag for me assuming that he was in contact with another billing co. & he was receiving direction elsewhere.

I advised him that the aging report was overlyyyyyy inflated as a result of him constantly billing for weight mgmt. related visits, ins company's requesting medical necessity documentation and denying claims for patients that are being seen on a "weekly" basis. I advised him many times over that the aging report is not accurate. He insists that he wants it "as is".

I meet with the doctor on June 26, 2013 (I received a phone call that morning from the software company advising that a woman called them requesting the doctor's pt demographics info. They referred the call to me and I called her. She confirmed that the dr contracted her to do his billing. I addressed the situation to him & questioned what were his plans. I reminded him that we were still under contract & that notice would have to be given. He advised that he was going to use the new billing company and myself as a race to see who billed more. At the end of the month, he would see who was better and that billing company would stay. I advised him that I will not participate in his race & that I would service his account through the end of July, 2013.

I gave him a Final Invoice which included the past due bal & he gave me a check (which has been returned as "refer to maker") & he threatening me with a lawyer if I do not give him the a/r report. He is always in court suing everyone, including the IRS. Am I obligated to give that to him if his check was returned? Can he sue me? What recourse do I have to get paid?

Thank you!!!

Lisette
Submitted: 1 year ago.
Category: Legal
Expert:  Ely replied 1 year ago.
Hello friend. My name is Ely, and welcome to JustAnswer. Please note: (1) this is general information only, not legal advice, and, (2) there may be a slight delay between your follow ups and my replies.

I am very sorry for your situation.

Am I obligated to give that to him if his check was returned

Arguably, you are. This is because since the two of you are in a verbal agreement (just as binding as a written agreement), each of you owe each other a fiduciary duty to provide information. So if he requests something reasonably (i.e. the a/r report), there is no reason why he should not be provided with it. Also, not giving it to him will only make you look suspicious, and may drive his paranoia more.

Can he sue me?

Not unless you did something malicious or stole from him, and it does not look like it. To sue in a state court, one needs to have a "cause of action." There are numerous causes of action, such as "breach of contract," "negligence," "fraud," "unjust enrichment," etc., as well as causes of action rooted in statutory law. Every state has their own although they are very similar to each other in every state.

Here, he has no cause of action to pursue you in Court with if you have done everything properly.

What recourse do I have to get paid?

You can threaten to sue him, or do so. Possibly for two actions in one complaint:

BREACH OF CONTRACT: The elements of an action for breach of contract are: (1) the existence of a contract, (2) a breach of the contract, and (3) damages resulting from the breach. See Knowles v. C.I.T. Corp., 346 So.2d 1042, 1043 (Fla. 1st DCA 1977).

MONEY HAD AND RECEIVED: A case where a party has money that rightfully belongs to you. Greenfield v. Manor Care, Inc., 705 So. 2d 926 - Fla: Dist. Court of Appeals, 4th Dist. 1997.

I hope this helps and clarifies. Best of luck.

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