A viewer works at a doctor’s office and knows there is billing fraud going on. What can she do? Attorneys Greg Fellerman and Ed Ciarimboli offer legal advice.
Dave Kuharchik: Time now for “The Law & You” featuring the area’s premier attorneys. Greg Fellerman is here. Ed Ciarimboli is here. The virtual law center is all set up, ready to go.
Greg Fellerman: And so is Dave Kuharchik. Our main man.
Ed Ciarimboli: You are Mr. WBRE.
Dave: Thank you, I guess. All right, here’s our question tonight. Betsy from Plymouth says, “I work at a doctor’s office where I know that billing fraud is going on.” What should Betsy do?
Ed: These cases, we’ve actually had a number of people call us on these particular types of cases. So this is called a qui tam case, or a whistleblower case. Essentially, what’s going on is you have insurance fraud, you have Medicare fraud, you have DPW fraud, any time billing is involved, there is fraud on many, many levels. So what happens is, depending on the nature of the fraud, you’re going to be the person who is going to report this. And let’s say ultimately this company pays a million dollar fine, as the whistleblower, you actually get a portion of that fine because you were the person who had the courage enough to bring it to the attention of the authorities.
Greg: And, that’s the civil side. But don’t forget, there’s a criminal side to it where you now have witnessed a felony or some sort of crime which you have an obligation to report to the proper law enforcement agencies. I can assure you, you will be getting immunity, you will not be charged. They will be looking at the doctor who is committing that fraud. But, as an employee, you witnessed this type of stuff, you have an obligation to do it. It just makes sense. Any type of fraud in any type of insurance is not good. So I think when you do that, you’re helping everyone keep the cost down for everybody else. So the insurance coverage is paying for what they should be paying for, real services.
Ed: And they want to give an incentive for people to report things like this. Which is why they allow the whistleblower to actually make a monetary recovery in this.
Dave: And in a case like this when you’re not sure, you can give the guys a call, check them out online or even reach out on social media. Results matter. Attorneys Greg Fellerman and Ed Ciarimboli, thanks, guys.
Greg and Ed: Thanks, Dave.
The Law & You is a nightly feature on channels WBRE-TV 28 and WYOU-TV 22 where the attorneys from Fellerman & Ciarimboli answer legal questions. If you have a question that you want answered by the Law & You attorneys, please submit the form on this page or call the hotline at 1-888-570-HURT.