My Dental provider billed me for something my insurance paid them for is this fraud?

My dental clinic told me that my oldest son was not covered at time of service for an exam and cleaning in Jun 2016. The insurance company said they issued a check to the dental clinic and that the check did clear. The insurance company also stated my son was covered at time of service and there was no break in service. I need to know if this is an issue of fraud and if so what kind? Double billing?

Asked on June 5, 2017 under Business Law, Georgia

Answers:

SJZ, Member, New York Bar / FreeAdvice Contributing Attorney

Answered 3 years ago | Contributor

It may be fraud, if they knowingly lied to you about coverage and payment. It may be theft by deception, if they "tricked" you into paying when you did not have to and so stole your money by trickery. In no event are they entitled to your money if they were independently paid for the work: they don't get to double collect. You could sue them (e.g. in small claims court, as your own attorney or "pro se") for the money if they won't return it. In the suit, you would present proof that the insurer paid them.


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