
When an HMO accuses a physician of overcharging for services, also put simply as “insurance fraud,” the situation can become dangerous for the doctor. At worst, the HMO can report the doctor to the Department of Health with the charge of fraudulent billing. If that happens, the doctor may have to repay a good deal of money to the HMO. Furthermore, there may be an OPMC investigation. The doctor should consider negotiating a settlement with the HMO to put the matter to rest. An insurance fraud attorney can help with this.
If you are going to bill an HMO, as a medical provider in private practice, it is in your best interests to have your staff retain a billing firm to guide your practice through proper billing. Not only will this information keep you out of a billing issue with the HMO, but you will also learn how to legally maximize your billing to capture the highest amount permitted.
As a healthcare professional, you should avoid evidence of over-billing because a claim can cost you deeply through forced repayment and an allegation of insurance fraud with the Department of Health or the Department of Education.
It is important to protect yourself from these matters. If you are accused of insurance fraud, you need quality legal representation to protect your practice, your license, and your future. Walker Medical Law has over 50 years of experience protecting the rights and livelihood of medical professionals with New York State licenses.
Our firm understands how serious insurance fraud is to the reputation and future of our clients, and we will do everything we can to help you come to a positive conclusion. If you need help with an insurance fraud issue, contact one of our experienced Insurance Fraud Defense Attorneys at Walker Medical Law for a free initial consultation.
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