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Feb 19, 2013

What Is No-Fault Insurance Fraud?

In addition to many widely-publicized cases of Medicaid and Medicare fraud, some health care providers in New York City may face charges of no-fault automobile insurance fraud. This is especially applicable in the case of health care providers that provide services commonly necessary for victims of automobile accidents, such as chiropractors, pain management specialists, neurologists, and others.

When such medical professionals are accused of assisting patients in submitting fraudulent claims in order to obtain reimbursement under New York?s no-fault law, charges may include health care fraud as well as mail fraud.

If the alleged fraud occurs as part of a wider conspiracy, a number of professionals may be involved in addition to the health care providers, including personal injury attorneys who purposely refer clients to the medical professionals in order to submit fraudulent claims.

New York State Law requires every vehicle registered in New York State to have no-fault automobile insurance, which entitles the driver and passengers of a registered and insured vehicle to obtain benefits of up to $50,000 per person for injuries sustained in an automobile accident, no matter who was at fault in the accident (the ?No-Fault Law?).

The No-Fault Law provides for prompt payment for medical treatment, so that claimants do not need to file personal injury lawsuits in order to be reimbursed. Under the No-Fault Law, patients may assign their right to reimbursement from an insurance company to other parties, including medical clinics that provide treatment for their injuries.

New York State law also prescribes that all New York medical clinics be incorporated, owned, operated, and/or controlled by a licensed medical practitioner in order to be eligible for reimbursement under the No-Fault Law. Insurance companies will not reimburse claims for medical treatments from a medical clinic that is not actually owned, operated, and controlled by a licensed medical practitioner.

Any fraud that is designed to circumvent this law and to obtain insurance reimbursements to which the claimant or the medical provider is not entitled, constitutes health care fraud.

For example, in some cases, medical clinic owners pay licensed medical professionals, including doctors and chiropractors to form professional corporations for the clinic through which clinics then bill the insurer under the no-fault law. Since the owners retain control and ownership of the clinic in everything but name, such transactions are considered fraudulent.

Medical professionals who bill insurance carriers under the no-fault law for treatments that either did not take place or were not medically necessary, also commit health care fraud.

When a doctor or a medical clinic received kickbacks for referrals to for extraneous services or treatments, such as physical therapy, MRI, orthopedics, and others, they are also committing health care fraud.

Conviction on these charges can result in imprisonment and severe fines, as well as harsh professional consequences such as revocation of medical license and exclusion from government insurance programs. Practitioners should be aware that such exclusion doesn?t just mean one may not perform a treatment and bill a government program for it ? it means that one may not be involved in any aspect of submitting a claim to a government program, including purely administrative aspects.

If you are concerned that you or a clinic you are affiliated with is being investigated for no-fault insurance fraud, you should retain an experienced health care fraud defense attorney. You should be aware that even if the clinic retains its own attorney, in the event that your interests diverge in any way from the clinic?s, that attorney?s loyalty is to the clinic. You need your own attorney, whose knowledge and expertise will be completely at your service.

Call our experienced NYC?health care?attorneys at? (212) 577-6677 to schedule an immediate consultation.

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Astoria, NY 11106

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14th Floor,
Brooklyn, NY 11201

Phone

888-977-6335