How Can Billing Fraud Affect a Medical Professional?

When a doctor provides a service for a patient, they are charged with medical bills. Depending on the service, the patients usually expect a certain price. There are some cases in which they may see a price that is higher than expected. Sometimes, a third party may notice the increase in price as well. When this happens, the medical professional may be audited for billing fraud. Billing fraud is when a doctor is overcharging their patients.

When a medical professional commits billing fraud, an insurance company may choose to audit the doctor and their office to get to the bottom of the situation. When an insurance company conducts an audit, they may notice that patients are paying more than they should be. This can cause the medical professional to face certain consequences for taking advantage of a patient. In addition to this, they may face penalties from the Office of Professional Medical Conduct (OPMC).

What is the OPMC?

The Office of Professional Medical Conduct works to ensure that medical professionals are practicing medicine based on the lawful standard of care. To do this, they monitor the bad situations that a doctor may find themselves in. Medical professionals sometimes find themselves guilty of a moral mistake. This is when the OPMC steps in to handle the matter. Billing fraud falls under a moral issue. Other matters that the OPMC may deal with include insurance fraud, substance abuse issues, sexual misconduct, and license revocation or restoration. When the OPMC finds a medical professional guilty of such wrongdoings, they can impose certain penalties and consequences.

Consequences of Billing Fraud

When a healthcare professional is involved in billing fraud, it can have a serious impact on their life and career. While the professional may not lose their medical license because of the act, they can still face various consequences for their actions. When the individual faces the OPMC, their case will be presented and the board will reach a decision regarding their charge. If the medical professional is found guilty, the OPMC may enforce a range of penalties.

When dealing with billing fraud, the OPMC may require a doctor to pay back large sums of money to avoid any further charges. Paying this money can not only impact their finances but also their reputation as a professional. If a patient hears this information about their doctor, they may wish to change to another physician. This has the power to lead the medical professional to a worse financial situation in the event that they begin to lose patients as a result of their wrongdoing.

Contact our Firm

When a medical professional is accused of misconduct, it is essential that they retain strong legal representation. If you require a medical law attorney for your legal matters, call Paul E. Walker, an experienced New York City OPMC & OPD Lawyer. Please contact the Walker Medical Law firm to set up a free initial consultation.