When an insurance company believes that it was over billed by a physician, there are many steps that need to be taken in order to prove that this injustice occurred. One of the most important steps here is to come up with a demand letter entailing the amount of money that you were over billed by the doctor. The insurer will need to come up with the numbers or percentages that state just how much money they believe they were overcharged by. Of course, there are also a number of steps that need to be taken on the physician’s end in order to prove that they are not guilty of this accusation.
If you are the doctor in this situation and you receive a demand letter from an insurance company, you will need strong legal representation who can assist you in this matter. Your best bet may simply be to settle on the matter and pay up. You can have your own auditor prove that the amount you billed the insurance company was the correct amount. If you choose not to settle and fight the insurance company, be aware that your relationship with them may be ruined from here on out. Something else that you should be aware of is that this situation might land you in question with the OPMC and you may actually lose your license as a result of fraudulent behavior that has occurred.
If you were accused of billing fraud, you will require the services of an experienced attorney who can walk you through this difficult process and assist you in trying to keep your medical license. Contact Walker Medical Law to discuss the facts and circumstances surrounding your case.
Walker Medical Law serves the greater New York City area with integrity and effectiveness representing physicians and other medical providers facing legal and license issues. If you need quality legal services, contact our New York office for a consultation.