Fraudulant insurance claims denied would I still have to report?

A

Anon

Guest
Hello,

I unfortunately had a moderate amount of BS on my Insurance records I've had to deal with. I've had fraudulent claims put on my records from a psychiatrist and successfully got every single claim rejected, however the diagnoses code he was charging claims with still exists in my Insurance records. I was told that it was in the system marked as "Submitted in error", but will I still have to report it and provide the documents proving it was a mistake?

Not sure if I'd have to report this under the big medical history question of HAVE I EVER IN MY LIFE BEEN DIAGNOSED WITH... if the diagnoses was in all records marked as an error and was in itself fraudulent. Just in-case I crash a plane into a fiery ball of inferno and the FAA wants to see my medical records and see a big fat undisclosed mental health condition I wanna cross my t's and dot my i's here...
 
I was told that it was in the system marked as "Submitted in error", but will I still have to report it and provide the documents proving it was a mistake?
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Not a doctor nor a betting man but if I were the latter my money would be on ... "Absolutely!"

BTW ... being told they were "submitted in error" won't cut it as you will need real proof of such a claim.

Not trying to be harsh but this is the F.A.A. we are talking about here.
 
So if an MD’s office mistakenly billed my insurance for a hysterectomy I (male) have to disclose that on an FAA medical form? Knowing the FAA they would ask for more information.
 
So estimations are that'd I have to mark yes to 18m and get at least a HIMS AME and an actual psychiatrist evaluations and the whole 9 yards for a diagnosis submitted by error from a doctor I haven't even seen? Sounds pretty brutal seeing I have documentation saying it was an error.
 
Clip4 said:
So if an MD’s office mistakenly billed my insurance for a hysterectomy I (male) have to disclose that on an FAA medical form? Knowing the FAA they would ask for more information.
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In today’s climate they’d almost have to. :confused:
 
Clip4 said:
So if an MD’s office mistakenly billed my insurance for a hysterectomy I (male) have to disclose that on an FAA medical form? Knowing the FAA they would ask for more information.
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You don’t understand the FAA. In your example, the only proof they would accept to demonstrate that the hysterectomy billing was in error would be an exam demonstrating that you still had a uterus.
 
Would the insurance company that denied the claims have any documentation that would help?
 
The form says "have you ever been diagnosed with..." not "did anyone ever file an insurance claim". My instinct would be to file away any supporting documentation just in case but not go volunteering anything that hasn't been asked for.
 
cowman said:
The form says "have you ever been diagnosed with..." not "did anyone ever file an insurance claim". My instinct would be to file away any supporting documentation just in case but not go volunteering anything that hasn't been asked for.
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The standard is also "to the best of your knowledge". If, to the best of your knowledge, these codes were invalidated due to fraud, then you are answering truthfully. That said, if you can get something from the insurance company showing these were rejected for fraud, it will be easier to get that now than 10 years from now, should someone have a reason to look.
 
Perhaps I'm alone but I wonder if there isn't more to the story. Was this purely a case of insurance fraud or is there any relationship between the OP and the psychiatrist?

Even if it's just fraud and there is no connection at all between the OP & this psychiatrist it is still possible that the good doctor placed the diagnoses codes he was charging claims with in the insurance records also in the patient's medical records.

The F.A.A. won't care who's right or wrong. If you want them to approve a medical then you'll have to clear the matter with them.

Supposedly a man was denied over a tattoo ... so there's that to consider. :dunno:
 
Palmpilot said:
Would the insurance company that denied the claims have any documentation that would help?
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Yeah totally they have documents that literally say it was an error, mistake, and there were never any real services provided by the practitioner
 
Jeff Oslick said:
The standard is also "to the best of your knowledge". If, to the best of your knowledge, these codes were invalidated due to fraud, then you are answering truthfully. That said, if you can get something from the insurance company showing these were rejected for fraud, it will be easier to get that now than 10 years from now, should someone have a reason to look.
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Thank you good point
 
Daleandee said:
Perhaps I'm alone but I wonder if there isn't more to the story. Was this purely a case of insurance fraud or is there any relationship between the OP and the psychiatrist?

Even if it's just fraud and there is no connection at all between the OP & this psychiatrist it is still possible that the good doctor placed the diagnoses codes he was charging claims with in the insurance records also in the patient's medical records.

The F.A.A. won't care who's right or wrong. If you want them to approve a medical then you'll have to clear the matter with them.

Supposedly a man was denied over a tattoo ... so there's that to consider. :dunno:
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Yeah if you wanna go speculate on me being truthful then you can make up whatever crazy backstory you want, but no the facts of the case are there were fraudulent claims made by a psychiatrist I've never seen and I want to see if it's going to be a royal pain in the ass. Not sure why you would call a man like that a good doctor but I don't have to defend myself if you don't wanna believe me.
 
Half Fast said:
You don’t understand the FAA. In your example, the only proof they would accept to demonstrate that the hysterectomy billing was in error would be an exam demonstrating that you still had a uterus.
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The FAA is the FAA, but facts are facts. If the bills were fraudulent, the OP wasn't actually diagnosed with anything. If it were me, I'd not report it and I wouldn't spend any time worrying about it.
 
Clip4 said:
So if an MD’s office mistakenly billed my insurance for a hysterectomy I (male) have to disclose that on an FAA medical form? Knowing the FAA they would ask for more information.
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If the insurance claim accompanied a diagnosis that you had a prolapsed uterus they might at least want more background
 
If the doctor never saw you how did he get your name and billing information?

Sounds like you should gather any documentation available, if possible an official statement from the insurance company to the effect of, "Dr. xxx fraudulently billed insurance for services that were never provided to Mr. xxx and never saw or treated Mr. xxx,", and keep a copy of that forever in case it comes up... but don't report it to the FAA. A copy of any court proceeding against the doctor would be good to have, too.
 
I once called a drs office asking why they sent me a check for $10. You overpaid your copayment!

what? I’ve never seen this person and live in another state!

no idea what codes they charged insurance under. This was maybe 30 years ago. Medical fraud must be lucrative.
 
Without delving into OP's situation:

IMHO Medical fraud is lucrative and possibly widespread. Computer billing systems are designed by people who don't use them. (To modify Peters) People rise to their level of marginal incompetence and remain there unless there is an organizational need in which case they get promoted-- often to CEO. Some or all of these intersect.

From my own experience-- with doctor's offices using incorrect procedure codes, or billing two immunizations given to siblings on the same visit as both being administered to one-- I'm sure that insurance companies view what constitutes "fraud" differently than "real people" do. A health care company was recently indicted for an organized scheme to find "donor" health insurance accounts to place otherwise uncollectable debts "really" incurred by a "real clinic" that provided "real services" to "real patients." The problems were that the patients really didn't have insurance, and the insurer really didn't check until someone (not the insurance company) went to the prosecutor's office.

So, with the OP I'm unclear if it's on a medical record... Or on an insurance company's records (which employers have access to regardless of any statute).

Is it pure fraud (for financial gain)... OP doesn't know doctor, that office just tried to bill.
A minor variation on above where services were actually rendered to another but knowingly charged to an uninvolved 3d party.
The result of incompetence, services rendered, but unknowingly charged to wrong party.

Services of some type rendered by doctor to OP but not as described.
___Could be fraud because different diagnosis pays better, or someone in office was stealing pharmaceuticals, or someone hated him.
___Could be incompetence, mixed up files, wrong billing code...

Services rendered by doctor by OP but there was a disagreement over diagnosis, eventually resolved in OPs favor.
___Could have been a clerical or labratory error.
___Doc could have been wrong (or on shaky ground) and not wanted litigation.

My ticket is important to me, for many of us it is our livelihood, to me this is a LEGAL matter and requires a legal answer from an aviation attorney.

This is the free advice of SGOTI and even with a double-your-money-back guarantee...
 
cowman said:
The form says "have you ever been diagnosed with..." not "did anyone ever file an insurance claim". My instinct would be to file away any supporting documentation just in case but not go volunteering anything that hasn't been asked for.
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I'm thinking along this line. And I would make sure any beneficiary on Life Insurance I had knew about it. Unless I had verified that this wouldn't be an issue for them collecting.
 
Anon said:
Yeah if you wanna go speculate on me being truthful then you can make up whatever crazy backstory you want, but no the facts of the case are there were fraudulent claims made by a psychiatrist I've never seen and I want to see if it's going to be a royal pain in the ass. Not sure why you would call a man like that a good doctor but I don't have to defend myself if you don't wanna believe me.
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Didn't say I didn't believe you but I have no idea who you are or what the story is. My reference to him being a "good doctor" was totally tongue in cheek. If it's a total scam by this doctor then your paperwork proving that should be sufficient to settle this but I would be honest with the AME/FAA about this during a consult.

Did not mean to offend you.
 
Daleandee said:
but I would be honest with the AME/FAA about this during a consult.
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Telling the FAA about a subsequently-removed fraudulent Dx code in your record is like telling U.S. Customs "yeah, I put Cuban cigars in my suitcase before crossing the border, but, honestly, I took it out already.

There is nothing, ever, to be gained by volunteering extraneous information to a government agency.
 
Jeff Oslick said:
Telling the FAA about a subsequently-removed fraudulent Dx code in your record is like telling U.S. Customs "yeah, I put Cuban cigars in my suitcase before crossing the border, but, honestly, I took it out already.

There is nothing, ever, to be gained by volunteering extraneous information to a government agency.
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We disagree and that's OK. Asking the AME about this during a consult can't hurt. If they say to ignore it then you have them in your corner. I try to live by honesty being the best policy ... and yes I know we're talking about the F.A.A. here.
 
Daleandee said:
We disagree and that's OK. Asking the AME about this during a consult can't hurt. If they say to ignore it then you have them in your corner. I try to live by honesty being the best policy ... and yes I know we're talking about the F.A.A. here.
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Since it was a psychiatrist the OP had never seen, it sounds like he was not actually diagnosed.* If that is the case, then if the OP were to write in MedXpress that he was diagnosed, that would not be honest.

As to whether it would be a good idea for him to volunteer to the AME that there was a psychiatrist who lied to an insurance company about him and got caught, I have no idea.

In any case, I hope he has something in writing from the insurance company to corroborate the fraudulent nature of the claim.

* Or is it possible for a psychiatrist to diagnose someone over the phone?

[Disclaimer: Like most people here, I have no expertise in these matters.]
 
Last edited:
Anon said:
Hello,

I unfortunately had a moderate amount of BS on my Insurance records I've had to deal with. I've had fraudulent claims put on my records from a psychiatrist and successfully got every single claim rejected, however the diagnoses code he was charging claims with still exists in my Insurance records. I was told that it was in the system marked as "Submitted in error", but will I still have to report it and provide the documents proving it was a mistake?

Not sure if I'd have to report this under the big medical history question of HAVE I EVER IN MY LIFE BEEN DIAGNOSED WITH... if the diagnoses was in all records marked as an error and was in itself fraudulent. Just in-case I crash a plane into a fiery ball of inferno and the FAA wants to see my medical records and see a big fat undisclosed mental health condition I wanna cross my t's and dot my i's here...
Click to expand...

FAA doesn’t practice real medicine and care about if real docs diagnosed you or didn’t, if there’s a record they’ll make up their own story and you have to disprove it to administrative law, if you’re successful at 100% showing you don’t have the issue the FAA can always just ignore everything.

This is what happens when you let department of transportation workers play doctor
 
Dana said:
If the doctor never saw you how did he get your name and billing information?
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In a case that made the news a "health care organization" that ran a clinic for people who were uninsured (as well as hospitals and doctor's practices) allegedly used their organizational database to match up unpaid expenses from that clinic with insurance accounts that were likely to pay for the services rendered (to others) by matching age, gender, eligibility, and other criteria including the policy limits so no audits would be triggered.

If true it was a sophisticated case of corporate fraud (like with Volkswagen's diesel engine computer programming).
 
Lois said:
In a case that made the news a "health care organization" that ran a clinic for people who were uninsured (as well as hospitals and doctor's practices) allegedly used their organizational database to match up unpaid expenses from that clinic with insurance accounts that were likely to pay for the services rendered (to others) by matching age, gender, eligibility, and other criteria including the policy limits so no audits would be triggered.

If true it was a sophisticated case of corporate fraud (like with Volkswagen's diesel engine computer programming).
Click to expand...

I thought I read a story here where the FAA outed people with AIDS?

It’s the FAA, a group of DOT workers who got high on their own supply. Beware self righteous gov workers
 
BladeSlap said:
I thought I read a story here where the FAA outed people with AIDS?

It’s the FAA, a group of DOT workers who got high on their own supply. Beware self righteous gov workers
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Can you find that story and post a link? It is so easy to say “I thought I read a story that said __________” and fill the blank in with whatever BS you want to in order to besmirch a person or organization without offering any proof.
 
SkyDog58 said:
Can you find that story and post a link? It is so easy to say “I thought I read a story that said __________” and fill the blank in with whatever BS you want to in order to besmirch a person or organization without offering any proof.
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It was on POA, some FAA feel good action that snooped into record they shouldn’t have access to

You seem to have lots of support for the faa, do you work in the industry?

Every FAA type I have met has been pretty disappointing
 
BladeSlap said:
It was on POA, some FAA feel good action that snooped into record they shouldn’t have access to

You seem to have lots of support for the faa, do you work in the industry?

Every FAA type I have met has been pretty disappointing
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Is that “No, I can’t find it,” or “No, I’m not going to try”?
 
Ah…preventing/prosecuting fraud is a “feel good action”.

Good thing they changed the medical form so they can “feel good” legally now.
 
MauleSkinner said:
Ah…preventing/prosecuting fraud is a “feel good action”.

Good thing they changed the medical form so they can “feel good” legally now.
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What?

Dude, pro tip, don’t drink the koolaid

But maybe you’re right, let’s trust the people who don’t trust evidence based medicine, don’t trust all the advances and experiences humanity has had with health and science, and are afriad to stand up against science and the burden of proof.

Because when one thinks of health and science, they naturally think of….the department of transportation o_O
 
BladeSlap said:
What?

Dude, pro tip, don’t drink the koolaid
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You stated the FAA action in this case was a “feel good action”. That action was detecting/prosecuting fraud.

the way they went about it was illegal, and they changed the medical forms to make the method legal.

Where’s the kool aid?
 
MauleSkinner said:
You stated the FAA action in this case was a “feel good action”. That action was detecting/prosecuting fraud.

the way they went about it was illegal, and they changed the medical forms to make the method legal.

Where’s the kool aid?
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Did you read that wiki article? And what’s your favorite flavor of boot polish?

prove to me me where those airmen were a hazard
 
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