How Will Insurance Fraud Affect My Medical License?

If you are a physician that is going to bill the Health Maintenance Organization (HMO), then it may be in your best interest to have your staff retain a billing firm to guide your practice through proper billing. Otherwise, you may come across a billing issue with the HMO that will put your medical license in danger. Follow along to find out how insurance fraud can affect your medical license and how a proficient New York insurance fraud attorney at Walker Medical Law can help you avoid this.

What is considered insurance fraud?

Put simply, insurance fraud by a physician occurs when false or misleading information is provided to the HMO so that a policyholder, medical organization, or another party can receive unauthorized benefits. Ways in which a physician can commit health insurance fraud are as follows:

  • A physician bills for procedures that were never performed.
  • A physician misrepresents procedures that were performed to obtain payment for non-covered procedures or more costly procedures.
  • A physician falsifies a patient’s diagnosis to bill for procedures that were not necessary.
  • A physician waives a patient’s copay and over-bills the insurance company.

This is not considered an innocent mistake. Rather, health insurance fraud is considered a crime that comes with serious repercussions.

What happens if I am accused of insurance fraud?

If the HMO accuses you of purposefully overcharging for your services, then they may report you to the Department of Health. With the HMO claiming a fraudulent billing charge, you will likely have to repay a significant amount of money to the HMO. This amount is essentially a repayment of what they accused you of overcharging.

What’s worse is that you may also have to undergo an investigation by The Office of Physician Medical Conduct (OPMC). With this OPMC investigation, you may risk losing your medical license for a significant period of time, if not permanently.

How will insurance fraud impact my medical license?

If you are accused of insurance fraud, it is possible that this was an isolated incident or that this was a simple mistake that can be easily corrected. In this case, you should consider negotiating a settlement with the HMO to put this matter to rest. However, if this is a more serious case, you may suffer greatly from the forced repayment and/or the forced revocation of your medical license.

To avoid this altogether, you must retain the legal representation of a talented New York insurance fraud attorney. We may be able to piece an argument together that shows that you were legally maximizing your billing to capture the highest amount permitted, or otherwise. So pick up the phone and give our firm a call today.