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Law Educator, Esq.
Law Educator, Esq., Attorney
Category: Legal
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Experience:  JA Mentor -Attorney Labor/employment, corporate, sports law, admiralty/maritime and civil rights law
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If a patient sees a physician and the health plan sends reimbursement

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If a patient sees a physician and the health plan sends reimbursement check to patient. Patient does not pay physician at time of service nor brings the check in to physician from the health care agency. Is that an offense of any kind?
Thank you for your question. I look forward to working with you to provide you the information you are seeking for educational purposes only.

It could be considered theft and it could also be considered insurance fraud if the insurance company sent a check to the patient based on the patient paying the medical bill and the patient failed to do so. Also, most times it is just grounds for the physician to just sue the patient for recovery of the bill due in small claims court. However, it could be considered criminal offenses and that would be up to the DA if the patient is taking checks from an insurer that were supposed to reimburse the patient for paying the doctor and they did not do so.

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Customer: replied 3 years ago.

Is there anything I could quote to patient in regard to your answer?

Thank you for your response. As we tell all customers repeatedly, we are a general information service, you cannot quote us because we legally cannot and do not represent you.

Here are the NY Insurance Fraud statutes, he has taken money from the insurer and has not used it for the purpose provided.
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