May 13, 2019
A Way to Attack Healthcare Fraud
by Lewis Fein
Unless we work to stop fraudulent claims, through the use of sound counsel, our healthcare system will continue to suffer.
If insurers want to mitigate risk, rather than risk their time and money with litigation, if they want to guard against fraudulent claims, if they want to protect good doctors against wrongful claims, then they should invest in sound legal counsel.
Insurers should highlight the value of retaining healthcare lawyers with the intelligence to know—and the strength to do—what is necessary to defeat false allegations of fraud or abuse. A doctor’s career can hang in the balance when defending against a professional liability claim.
Without sound counsel, our best doctors may not be able to practice medicine. Unless we work to stop fraudulent claims, or make it more difficult for fraudsters to enlist the government to pursue these claims, our healthcare system will continue to suffer. Stopping this injustice starts with healthcare lawyers in search of justice—namely, healthcare lawyers whose expertise doctors need.
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According to Fenton Law Group, which specializes in defending healthcare providers against allegations of fraud and abuse, the charges themselves have their own nuances and degrees of sensitivity.
Take the firm’s representation of Dr. Alwin Lewis (Lewis v. Medical Board) before the Supreme Court of California, regarding a purported violation of a patient’s privacy rights. Because HIPAA prevents people from delving into personal medical records, an insurer cannot muster much of a defense without access to and knowledge of the very things that would exonerate a doctor from a wrongful claim.
Bear in mind, too, that insurance companies often hire panel counsel to defend against claims of fraud. Which is not to say that all insurance companies put savings ahead of saving doctors from fraudulent claims.
Given these circumstances, doctors need effective counsel. Insurers should, in turn, at least listen to what healthcare lawyers have to say about what constitutes a smart legal strategy.
Perhaps elevating the role of defense counsel will benefit insurers, reducing the number of fraudulent claims by increasing the difficulty of bringing claims against doctors who have done nothing wrong. Perhaps hiring the right healthcare lawyers is the right thing do.
Perhaps, indeed; but until then—until the honest unite against the dishonest—we need defense lawyers who can expose fraudulent claims and dismantle claims of fraud against innocent doctors.
We cannot afford to do otherwise. Not if we want to preserve our healthcare system and protect our preferred providers of healthcare.
We cannot afford to have insurers settle all fraudulent claims, either, because we will pay the price for these payouts in higher premiums and deductibles.
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The price will come at the expense of choice, leaving us with one of two choices: less affordable care or no care at all.
We must avoid that false choice.
We must have lawyers who champion our rights. We must have lawyers who defend the rights of doctors and healthcare providers. We must have lawyers who expand our rights.
To have lawyers at the forefront of this cause is a good thing, an altogether just and necessary thing.