insurance?

[brebre]

What is the name of your state? louisiana
currently my brother and his ex wife have joint custody of 3 healthy kids.they have a court order stating that he holds insurance and split anything over $100..recently for the month of Jan. alone he has recieved all kind of billing statements for the doctors office where she works at as the office manager.well the problem is that she has or supposed to be taking the kids to the doctor every 3 or 4 days. well she has never called him to tell him anything about taking them to the doctor, but when the son got bit by a spider in Dec. she called my brother about him. but the question is how can you take 3 kids to the dr. every 3 or 4 days all at the same time to the same dr. but when he speak to the kids once a week they stated they never been to the dr. that week or the week before. does this sound like a form of fraud and what type of trouble can she get in if any? also, by her using the dr. name on the insurance will he be liable for anything? he doesnt have a problem of paying his portion of the bill but it's just the point of her taking them at least 12 times a month at the same time to the same doctor and there is really nothing wrong? any answer will be helpful..

 

[Pfaffing85690]

Send the bills to your attorney and have him/her verify with the DOCTOR the bills and demand treatment protocol records.

 

[brebre]

thanK you the reply, but what IF the doctor had no knowledge of this wrong doing on her behalf? then is there any other way for the atty to come to conclusion on how to help him on this matter ?

 

[brebre]

i meant thank you for the reply...the amount of of co-pay we came up with is $500 in one month the is just crazy.. not to be funny but i have never seen a chronic ill patient go to the doctor this much..

 

[kat1963]

Isn't he getting EOB's from the insurance company?
KAT

 

[nextwife]

Sure smells like fraud to me. No way these kid's doctor is seeing them every 3-4 days AND billing in excess of $100 each of those so-called visits.

 

[brebre]

as far as the EOB it only states when, dates, how much the insurance covered, and the amt.of the co-pay.if your asking the question does it state anything about what type of services they had. no it does not...I am really thankful for all the replies but i am just trying to find all the answer i can when it comes down to presenting this to his atty..we have been recording all the question that my brother have been asking the kids and they all say the same thing that they never been to the doctor..

 

[kat1963]

Obtaining a copy of the medical records should be an interesting read. I'd probably send request letter, then work from there.

Louisiana Revised Statutes 9:351.

Access to records of child:

Notwithstanding any provision of law to the contrary, access to records and information pertaining to a minor child, including but not limited to medical, dental, and school records, shall not be denied to a parent solely because he is not the child's custodial or domiciliary parent.

Here is an example:
http://www.deltabravo.net/custody/medrecords.htm

KAT

 

[brebre]

thank you for the post...i do recall visiting that website before..by the kat1963 which part of virginia are you in? currently i am residing in newport news.

 

[brebre]

this is going to nextwife..i just wanted to let you guys know that we spoke the insurance company. and they stated that the mother was/supposed to be taking the kids to the doctor for the same thing on the same day for the same services..come to find out that she was taking these kids to the chirop.(sp?)..so the insurance company is going to contact the fraud unit and begin to press charges against the x...

 

[nextwife]

Thanks for letting us know! Good luck.

WE ALL end up paying for these shenanagins. Good thing the insurance company is checking it out.

 

[lsut1ger]

Oh lordy...been there, done that....

Just let your insurance company handle it. We have BCBS and just called and made their fraud division aware of our suspicions (i.e. excessive visits on EOB, no visible problems when child was in our care, mother's aunt was office manager). They handled it completely and we didn't have to lift a finger. They did the demands for patient records,etc. and about 2 or 3 months later we got a statement saying that $X had been DEBITED from the provider. Basically the provider owed the insurance co. that money back.

Nothing to worry about....and don't stress. Just alert your insurance co. and let them handle it.

 

[brebre]

lsut1 ger-------- lord and behold thank you for the information..i
just reallly looked the billing information online and she is up to her same old tricks.she just took the kids to the doctor again on the 16th for the same thing..so the insurance called and told us that they have to investigate the matter with the doctor to find out if he have seen the kids. I have a question what can happen to him if he didn't perform the service and he was not aware of the situation? and I don't believe she is paying for the co-pay as well if she is the office manager.can she get jail time for this or just the cost of the services? I am glad i'am not alone : ) . please e-mail privately to tell me more,, or so that we can exchange information..later