Meritorious Cases Caught in a Web of Fraud

Recently, Florida arrested several individuals associated with insurance fraud.  The alleged fraud stems from medical clinics abusing Florida’s “No Fault” insurance laws in order to make a profit by orchestrating staged auto accidents and/or billing for treatment that was not performed on the patient.  With regards to clinics billing for treatment never performed, the insurance industry has cracked down on this type of fraud by interviewing those that received treatment, under oath, to determine what treatment the patient received at the clinic and cross-referencing the testimony with the actual medical bills submitted by the clinic as part of a claim.

Although I encourage any entity in investigating and pursuing fraudulent insurance claims, many times, innocent victims that were truly injured in an auto accident get caught in the crossfire.  I have had several clients that were sent to a clinic, by their friend or a referral service, which is under investigation for fraudulent billing.  The unsuspecting victim gets legitimate treatment, but unbeknownst to them, the clinic also bills the insurance company for treatment that the victim did not receive.  We then attend an Examination Under Oath (EUO) conducted by the insurance company where, for the first time, we find out that that suspected clinic has actually billed for treatment that the victim did not receive.  Of course, we immediately look for a different clinic if more treatment is needed, but the damage to the victim’s meritorious claim has been done.

You may be wondering how the victim’s meritorious claim has been impaired due to the actions of the clinic.  First and foremost, the key to any case before a jury is credibility of the Plaintiff’s case.  When the Defense Attorney can attack the credibility of the doctor and treatment that was being provided to the victim the jury begins to doubt the credibility of the injuries to the victim along with any legitimate future medical treatment that is needed.  This is especially so if the victim received all of their treatment from the clinic before they found out that the clinic was inappropriately billing the insurance company.  Further, even if the victim does find out in the early stages of their treatment, when one changes doctors in the middle of treatment the Defense Attorney accuses the victim of doctor shopping for the doctor that will provide the best diagnosis for a big verdict.

What can you do to protect yourself if you are in an accident and need medical attention?  First, make sure that if you are referred to a clinic, the referral comes from someone you know and trust.  Do not call some referral service with a fancy name or phone number unless you know, for sure, that they are looking out for your best interests as opposed to the clinic and attorney they have referred.  If you have hired an attorney, ask them if they know of the clinic’s reputation in the community.  Many times, the attorneys know or find out about scrupulous clinics well before other entities.  Above all, follow your gut instincts.  If you feel like the clinic you are receiving treatment from is not on the up-and-up, you are probably right and you should not risk your health or financial wellbeing on a clinic you suspect is not legitimate.