Question
What is the name of your state? Michigan
I am wondering if this is insurance fraud and what would happen if so?
I have a Friend of the Court situtation with Dental coverage. Unless I send in bills within the year incrued they are not reimbursed to me. This has happened before.
I could not find the bill from the dentist. I printed my own bill (similiar to the one I originally had) but this showing payment for services rendered. At the time, I had not yet made payment.
My dentist told me to wait until they send it in again. So therefore no out of pocket payment was made. I can not send in bills to FOC unless I make a payment after insurance has been applied. Since I did not want to miss the year window again, I sent in a proof of payment when no such had been made.
I sent this along with my EOB showing coverage and my ex's showing no coverage. At the time, I did have a balance owing on my account.
After this was submitted to FOC, my ex's insurance ended up denying additional coverage. The dental office wrote off the uninsured amount. I had no out of pocket expenses. Because my ex's EOB's finally went to the FOC his amount due was removed. He paid no out of pocket expenses.
Because I sent in a statement showing I paid when I did not, is this a fraudulent claim to FOC or my ex?
What are the consequences I could face?
Any advice on how I could handle this as I was not intentionally trying to get any money that was not due to me?
My ex knows no money has been paid by me or himself and the FOC has credited him. As far as FOC is concerned, it's over. My ex is pursing this issue as a insurance fraud claim. How he will do that I am not quite sure. I just would like to be prepared for the worse.
Answer
I've read your post several times and am not clear exactly what happened.
Did you receive reimbursement that you were not entitled to?
Answer
No both insurance companies paid their portions accordingly. No out of pocket on my side or my ex's.
My concern is my ex may press charges for insurance fraud because I submitted a paper stating I paid by credit card. I could not produce a copy of the visit (you can only get them at the visit) so I retyped one myself. It looks just like the Dr. office.
I had not paid at the time I submitted the form to the FOC. I was going to pay on the next 6 month check up visit. By then, all was paid in full by the insurance companies.
Again, the concern is just is it illegal to type a form and mark paid when you did not do so? I may even have this question in the wrong area? Not clear if this could be insurance fraud or falsefying documents or whatever it could be??
Answer
If you caused your insurance company to pay for something it would not have normally paid by falsifying documents, then that is insurance fraud.