Is it illegal to lie to an insurance company to obtain benefits for a patient?
Get Legal Help Today
Compare Quotes From Top Companies and Save
Secured with SHA-256 Encryption
Is it illegal to lie to an insurance company to obtain benefits for a patient?
I work for a third party company who verifies insurance for patients to obtain specialty medication. We call health insurance companies and state we are calling for the drs office to obtain these benefits. A lot of times we get third partied and told they cannot provide us information. Recently my management team has told us to lie about where we are calling from in order to obtain the benefits. I know this is unethical but I was also wondering if lying to the health insurance company has any legal consequences. I want to make sure I do not
break any laws by doing what my management team says and lying to obtain personal health information of a patient.
Asked on July 9, 2019 under Insurance Law, Pennsylvania
Answers:
S.L,. Member, California Bar / FreeAdvice Contributing Attorney
Answered 5 years ago | Contributor
You and your employer could be sued for fraud for lying to the insurance company.
Fraud is the intentional misrepresentation of a material fact made with knowledge of its falsity and with induce reliance upon which the other party justifiably relied to its detriment.
In other words, the insurance company would not pay for the medication had it known the true facts.
IMPORTANT NOTICE: The Answer(s) provided above are for general information only. The attorney providing the answer was not serving as the attorney for the person submitting the question or in any attorney-client relationship with such person. Laws may vary from state to state, and sometimes change. Tiny variations in the facts, or a fact not set forth in a question, often can change a legal outcome or an attorney's conclusion. Although AttorneyPages.com has verified the attorney was admitted to practice law in at least one jurisdiction, he or she may not be authorized to practice law in the jurisdiction referred to in the question, nor is he or she necessarily experienced in the area of the law involved. Unlike the information in the Answer(s) above, upon which you should NOT rely, for personal advice you can rely upon we suggest you retain an attorney to represent you.