What Happens if a Physician is Accused of Insurance Fraud?

If you, as a physician, are accused of insurance fraud by a Health Maintenance Organization (HMO), then you may be entering dangerous territory. Continue reading to learn more about what will happen if you overcharge an HMO and how an experienced New York insurance fraud attorney at Walker Medical Law can come to your defense.

What happens if I am accused of insurance fraud?

Put simply, if you, as a physician, are caught overcharging for your services, then an HMO may accuse you of insurance fraud. It is possible that this may be an isolated incident and a simple mistake that can be easily corrected.

However, if the HMO believes that you have been purposefully overcharging for your services, then they may report you to the Department of Health and claim a fraudulent billing charge. With this, you will likely have to repay a significant amount of money to the HMO, that is refund the amount you allegedly overcharged, to make this go away.

In addition, it is possible that you may have to undergo an investigation by The Office of Physician Medical Conduct (OPMC). With this, you may have to negotiate a settlement with the HMO to make this go away. Ultimatley, when an OPMC investigation is launched, you may risk losing your medical license for a significant period of time.

What is the resolution to being accused of insurance fraud?

If you will like to avoid this situation altogether, it may be in your best interest to retain the services of a billing firm to work on your behalf and ensure that you are appropriately billing an HMO. As a medical provider operating a private practice, you cannot afford to accidentally overcharge an HMO. Thus, a billing firm will help you avoid such legal issues while also educating you on how to legally maximize your billing to obtain the highest amount possible.

How can a lawyer help me resolve this issue?

In addition to a billing firm, it is in your best interest to retain the services of one of the skilled New York physician defense lawyers from our firm. For one, we can work on your behalf in negotiating a fair settlement with the HMO. Also, we will do everything in our power to prevent such drastic consequences to be inflicted on you, such as losing your medical license. We believe that you should continue to practice medicine and that this incident should not get in the way of that.

For more information, pick up the phone and give us a call at your earliest possible convenience.