What if my Health insurance sent me the money for a claim and I spent it myself?

Asked about 3 years ago - Mission Viejo, CA

I went through beverly hills surgeons to request a lap band procedure. The clinic turned out to be pretty much a fraud themselves. But anyhow long story short my insurance company refused to pay the claim to them because they didnt currently have a license so they sent the claim money to me in the amount of 6000.00. I winded up needing the money and spent it. Now I just got a certified copy of a letter over 2 yrs later that they sent to my insurance company saying if that I am commiting fraud against the clinic and if they send anymore payments for procedures rendered they will me co inspiring to commit fraud with me. What could happen to me? They never even tried contacting me for payments or anything. I have no problem paying payments I can afford. But I havent heard anything till now.

Attorney answers (1)

  1. Randy William Ferguson

    Contributor Level 19

    Answered . I question why they sent the money to you if they did not have a license. Why did they cover it at all? If they could legally perform the work, you are legally obligated to pay the bill. Under no circumstances did you have a right to spend the money. It was the insurance company or physician's money. You should find out if they were licensed to perform the work in your town. If they were, you need to make arrangements to pay the bill, if not the money should be paid back to the insurance company. Call a local attorney for help if you can't get it worked out. They could file suit against you to recover the money. If they are not licensed, they would be crazy to do that though. Unsure in your state if they could file some type of criminal charge like theft of services or etc.


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