WHAT A MEDICAL PRACTITIONER NEEDS TO KNOW ABOUT INSURANCE FRAUD

If you, as a medical practitioner, are contacted by an investigator from an insurance carrier, a criminal investigator, a detective from the Office of the Insurance Fraud Prosecutor of the State Attorney General’s Office, a County Prosecutor’s Office, or an investigator from the State Department of Banking and Insurance, you should immediately seek legal counsel.  You should not speak with any type of investigator, until speaking with an attorney, who is experienced in the area of the defense of insurance fraud allegations.  You can download a “desk card” from our website to print and keep at the front desk of your practice.  Use it to address any of these situations.  (we’d also be happy to mail you one!)

I haven’t done anything wrong.  Why should I worry about this?  You should.  Here’s why:
An investigation, by a carrier or a state agency, can come about in a number of ways, without you doing anything wrong:

  • You or your employee made a mistake in a billing submission or a series of submissions;
  • Your patient is engaged in an insurance fraud; and, the investigation carrier or agency is checking all information concerning that patient’s medical billings;
  • Your employee is submitting inflated bills, without your knowledge, in a scheme to “pocket the difference”;
  • A patient, unhappy with the outcome of their treatment (or a close relative of the patient),decides to “get even” and cause some trouble or,
  • A disgruntled, former employee decides to “get even”; and, cause you some trouble.

YOU COULD HAVE DONE NOTHING WRONG; BUT, YOU STILL NEED THE ASSISTANCE OF AN ATTORNEY, WHO IS EXPERIENCED IN HANDLING INSURANCE FRAUD, TO PROTECT YOUR INTERESTS, GOOD NAME, AND MEDICAL LICENSE.

Anything you say to any of these investigators can be used against you in a court of law, including a subsequent investigation of what appears to be a civil regulatory infraction.  It can easily become a criminal investigation.

What is at stake?

  1. Your medical license;
  2. Under the statute, an insurance carrier can sue you for treble damages (up to 3 times the amount of the alleged fraud, including acts by any alleged co-conspirators), plus attorney fees and their investigative costs; 
  3. Your freedom; since, depending on the amount involved and other circumstances, you could be facing 3 to 5 years or 5 to 10 years in a New Jersey State Prison; and, more, if there are multiple incidents, charged as separate counts in an indictment.

What can an attorney, who is experienced in the area of Insurance Fraud, do for you?

  • If you have a valid explanation of the circumstances that are being alleged, an attorney can speak on your behalf to the investigating party in an attempt to resolve the matter, without litigation; and, if feasible, arrange a proffer session, wherein anything you say cannot be used in the direct case against you.
  • If you have inadvertently something wrong, by insurance regulations standards, an experienced attorney can speak with the necessary authorities in an effort to keep the matter in the civil arena; and, avoid a criminal prosecution.
  • If you are – or, it appears you will be, the subject of a criminal investigation, an attorney experienced in the area of insurance fraud can put forth your side of the case, in an effort to have the criminal investigation result in a finding of “no criminal intent”; or, in the alternative, to discuss the potential of Pre-Trial Intervention (akin to a probation period in which successful completion results in a dismissal of the charges); or, as a last alternative, make efforts on your behalf to avoid a prison sentence.
  • In each effort to resolve your civil, regulatory and criminal matters, an experienced insurance fraud defense counsel will keep in mind working out a resolution that has the least impact upon your licensing; and, will work with the medical licensing board, on your behalf, to mitigate any licensing board punishment.

At The Beinhaker Law Firm, Robert J. Brass, Esq., a former Deputy Attorney General with the Office of the Insurance Fraud Prosecutor of the NJ Division of Criminal Justice/NJ Attorney General’s Office, is available to counsel and assist you in all areas, relative to insurance fraud allegations, by the Office of the Insurance Fraud Prosecutor/NJ Division of Criminal Justice/Office of the Attorney General, a County Prosecutor’s Office, the Department of Banking and Insurance, a State Medical/Professional Licensing Board, and/or an insurance carrier.

Call Bob Brass at (908) 272-2232 for an appointment to discuss your situation, before it gets out of hand.There is no charge for an initial consultation. A link to Bob’s bio is available by visiting the Firm’s website.

In addition to protecting you against allegations of Insurance Fraud, the Firm provides medical collection services for “kept check” situations, as well as filing major medical reimbursement cases for out-of-network (non-participating) medical practices.  Our attorneys are available for no-fee initial consultations as well as in-house presentations for your medical billing staffs and office management.

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