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Zoey_ JD
Zoey_ JD, JustAnswer Criminal Law Mentor
Category: Criminal Law
Satisfied Customers: 27757
Experience:  Admitted to NYS Criminal defense bar in 1989. Extensive arraignment, hearing, trial experience.
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I've received health insurance checks out-of-network

Customer Question

I've received health insurance checks for an out-of-network health provider in my name alone. I've deposited some of them per the advise of my health insurance company and was told to wait on a bill, but later found I've been signing I'd endorse these and send straight to them. I had an unexpected large expense in the mean time. Is this criminal since I signed I would hand them over?
Submitted: 1 year ago.
Category: Criminal Law
Expert:  Zoey_ JD replied 1 year ago.
Hello, In order for this to be criminal the state would have to prove beyond a reasonable doubt that you appropriated this money for yourself never intending to use it to reimburse your physician. Chances are, however, that if you pay your medical bills before your doctor notifies your carrier, this will never become an issue, because your carrier won't even know of your mistake. If the doctor does notify your health insurance provider, the insurance company can turn the matter over for prosecution.
Customer: replied 1 year ago.
So it is criminal to spend the money on something else or is it just a debt to this provider? Does it matter that I signed that I would endorse/forward the checks?
Expert:  Zoey_ JD replied 1 year ago.
It can be both criminal and a civil debt. Most criminal matters have corresponding civil causes of action and vice versa. Signing paperwork saying that you'd endorse the check over to your carrier but not doing that could be seen as evidence of the intent to defraud, but if you do, in fact, pay your doctor when the bill comes due, that would be favorable evidence as to you. So, as I've said before, if your carrier gets no complaint, it's likely never to know. That doesn't of course, mean you should continue to do this. It is conversion (intentional tort in civil law) and theft of services under the penal code. You've got to pay off the doctor. If the carrier finds out that you cashed the checks first before sending them to your physician but doesn't find out until after the doctor is paid off, they are almost certainly not going to prosecute you because they'd have a hard time proving that you intended to defraud anyone. Nor would they sue you because they sustained no damages. They might, however, cancel your policy.
Customer: replied 1 year ago.
Okay, simply put, I've spent some of the money and don't have it all to pay the out of network lab that i signed I'd forward the checks to them. I just wonder what can happen if it's criminal or they can just sue me.
Expert:  Zoey_ JD replied 1 year ago.
They can sue you if they want. They can seek to have you prosecuted. They don't have to choose. They can do both if they wish. This makes out a civil offense -- it is conversion -- and it makes out a criminal theft offense. The burden of proof is more favorable to your insurance company if they sue you than it is for the DA to prosecute you. In civil court, they only have to prove conversion by a preponderance of the evidence. In criminal court the DA has to prove you intended to defraud beyond a reasonable doubt. On the other hand, it will cost the carrier money to sue, while the prosecutor is paid by the state to prosecute. I can't possibly predict what they'd do. You have to prepare yourself that either option might become a reality.