Legal Question in Health Care Law in Illinois

My orthodontist over billed my insurance company for services. I questioned him why it was so much and he said it was a billing error and instead of re submitting the bill he gave me a check for half while I was at my last appointment. Feeling completely overwhelmed and intimidated and not wanting to cause a scene I took the check. I have no intention of cashing it and want to mail it back to him with a letter explaining how I feel. Could I get in any trouble for taking the check if anything ever comes of this from an insurance fraud standpoint? Or as long as I don't cash it I'm fine. I was just so put on the spot and didn't know how to react. I feel like I have a loaded gun in my house. Help!


Asked on 3/04/13, 1:57 pm

1 Answer from Attorneys
Stephen Messutta

Taking money under these circumstances is insurance fraud. This is your insurance company, not the ortho's. If you know he overcharged you and that the company paid proceeds of your policy that were not correct, and allowed that to stand, that too is insurance fraud because you're allowing your ortho to steal from your insurance company. This is a terrible spot to be put in. The ortho should voluntarily return the excess or you should find an honest one and turn the bad one in, but be sure you have the proof first because you known this one will fight "tooth and nail" against you if you're wrong, so I'd start with the ortho first. Your insurance company will most likely not be able to do anything with the check the ortho gave you (third party checks are generally not accepted today) except investigate.

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Answered on 3/17/13, 1:30 pm


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