Legal Question in Insurance Law in New York

Re: Patient keeps fees meant for provider

You must have had an assignment of benefits.

That is the only way you can legally obtain someone else's benefits; once a patient does assign the payments that's how you prove it.

The insurer should send them to your office; this is why providers on assignment have an office staff to do billing.

Re: Patient keeps fees meant for provider

You are correct that you cannot prove a negative. Your recitation of the facts in small claims court would be sufficient evidence, if believed by the arbitrator or judge. I gather that this is how you proceeded. The judgment is valid unless later overturned on appeal or upon a request for reargument, neither of which is likely if the other side was present.

If the checks from the insurance company were made out to you but cashed by the patient, then you have a case of forgery and theft. If the patient told the insurance company that he paid you and requested reimbursement, then you had a case of insurance fraud. Such events should be reported to the police.

If neither of these circumstances was the case, just enforce the judgment.

It is apparent that you need to establish systems in your office to avoid these and similar problems. Please do not hesitate to contact us if you need help along these lines.