No-Fault Fraud Ruling: Surgical Center Cheated Insurers
In our law firm’s 30+ years of insurance litigation practice we have often questioned certain extraordinarily high medical bills submitted to no-fault insurers for payment. The $5,400 MRI or the $16,000 injection. It is natural to question the veracity of certain medical billings. The word fraud is never far behind. However, suspecting fraud and proving fraud are often two different things.
In a recent U.S. District Court case, the Court determined that a surgical center had been defrauding the Plaintiffs, three no-fault insurers, by using the wrong CPT codes for surgical procedures resulting in a $652,557.00 overpayment. The surgical center was billing for surgical treatments not provided to the insureds. The surgical center submitted a CPT billing code for the procedure charging $14,000 per procedure. The correct CPT billing code permitted a charge of only $128 per procedure.
In addition to finding fraud, the Court further reasoned that it would be “unconscionable” to permit the surgical center to keep the overcharges. The Court granted Summary Judgment in favor of the no-fault insurance companies which brought the case.
Read the entire case at: Hartford Accident & Indem Co, et al v Lakes Ambulatory Surgical Ctr, LLC.
About Alexander & Angelas, P.C.
Alexander & Angelas, P.C. represents defendants in civil liability litigation across Michigan and Northern Ohio. The firm’s practice areas include insurance defense litigation, premises liability, motor carrier (trucking) defense, corporate and commercial litigation, construction defect litigation, auto negligence, insurance coverage disputes, emergency casualty response services, alternative dispute resolution, subrogation claims, workers’ compensation, employment law, and liquor liability.
Attorneys practice in all state and federal courts in Michigan, including Wayne County (Detroit), Macomb County (Mount Clemens), Oakland County (Pontiac), Washtenaw County (Ann Arbor), and Genesee County (Flint). Legal services are also provided in Northern Ohio. Since its founding in 1992, the firm has litigated over 4,000 civil cases.
A 24/7 Emergency Hotline is available (800-219-0007) for trucking and insurance company clients. When an accident requires an immediate response to protect evidence, members of the firm quickly launch an investigation with the assistance of well-qualified accident investigators, crash re-constructionists, mechanical engineers, civil evidence photographers, and independent adjusters positioned throughout Michigan and Northern Ohio.
Alexander & Angelas, P.C. measures its performance based upon three key metrics: aging of claims, indemnity expense, and legal defense costs. The firm refuses to over-litigate cases merely to increase legal fees and strives to resolve matters within one year from initial case assignment.
Visit Alexander & Angelas online at https://www.alexanderandangelas.com/ for more information. Partner Peter A. Angelas is available to discuss a confidential matter.
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