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INVENTING ANNA

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How Lawyers Defend Against Healthcare Claim Fabrications

How Lawyers Defend Against Healthcare Claim Fabrications

Healthcare fraud is a serious issue that costs the industry billions of dollars each year. One common type of fraud involves patients or healthcare providers fabricating or exaggerating injury claims in order to receive higher insurance payouts. As a lawyer, it is important to have strategies to defend against fraudulent claims and protect your clients.

Investigating the Claims

The first step is to thoroughly investigate the claims being made. This starts with reviewing all medical records and documentation related to the alleged injury. Look for inconsistencies, missing records, or other red flags. Additionally, request to independently examine the claimant to look for signs they are embellishing or faking an injury. An experienced lawyer will know what details to look for[1].

Interview all relevant witnesses, such as treating physicians, nurses, coworkers, friends and family. See if their version of events matches up with the claimant’s story. Discrepancies in the details can reveal fabricated claims. Also look into the claimant’s background – do they have a history of fraudulent activities or making exaggerated claims in the past[2]?

Using Medical Experts

Retaining respected independent medical experts to review the claims is also essential. They can analyze if the medical evidence truly supports the alleged injuries, or if the records appear altered or do not match the stated symptoms. For example, soft tissue injuries like whiplash are commonly fabricated but an expert can identify inconsistencies. Have the expert thoroughly explain their analysis in a written report to use as evidence[3].

Challenging Suspicious Documentation

Scrutinize any documentation that appears suspicious, such as medical records that seem altered or bills for treatments that were never performed. Demand originals and run authentication tests. Question providers under oath about anomalies. Demonstrating a document is fraudulent can undermine the entire claim[4].

Deposing the Claimant

Deposing the claimant under oath is also an important step. This allows the lawyer to closely question them about inconsistencies in their story, especially details that do not match up with witnesses or records. Look for changes in their recollection or obvious signs of embellishment. Skilled lawyers can often get claimants making fabricated claims to contradict themselves or reveal lies during depositions[5].

Negotiating Settlements

Rather than going to trial, many fraudulent claims end up settling. This can still save substantially on payouts versus accepting the full exaggerated demand. A lawyer experienced in claim investigations can negotiate much lower settlements by presenting evidence of fabrication uncovered during discovery. Some claimants drop demands entirely once challenged with proof their claim is fraudulent.

Christine Twomey
Christine Twomey
2024-03-21
Just had my Divorce case settled 2 months ago after having a horrible experience with another firm. I couldn’t be happier with Claire Banks and Elizabeth Garvey with their outstanding professionalism in doing so with Spodek Law Group. Any time I needed questions answered they were always prompt in doing so with all my uncertainties after 30 yrs of marriage.I feel from the bottom of my heart you will NOT be disappointed with either one. Thanks a million.
Brendan huisman
Brendan huisman
2024-03-18
Alex Zhik contacted me almost immediately when I reached out to Spodek for a consultation and was able to effectively communicate the path forward/consequences of my legal issue. I immediately agreed to hire Alex for his services and did not regret my choice. He was able to cover my case in court (with 1 day notice) and not only was he able to push my case down, he carefully negotiated a dismissal of the charge altogether. I highly recommend Spodek, and more specifically, Alex Zhik for all of your legal issues. Thanks guys!
Guerline Menard
Guerline Menard
2024-03-18
Thanks again Spodek law firm, particularly Esq Claire Banks who stood right there with us up to the finish line. Attached photos taken right outside of the court building and the smile on our faces represented victory, a breath of fresh air and satisfaction. We are very happy that this is over and we can move on with our lives. Thanks Spodek law 🙏🏼🙏🏼🙏🏼🙏🏼🙌🏼❤️
Keisha Parris
Keisha Parris
2024-03-15
Believe every single review here about Alex Z!! From our initial consultation, it was evident that Alex possessed a profound understanding of criminal law and a fierce dedication to his clients rights. Throughout the entirety of my case, Alex exhibited unparalleled professionalism and unwavering commitment. What sets Alex apart is not only his legal expertise but also his genuine compassion for his clients. He took the time to thoroughly explain my case, alleviating any concerns I had along the way. His exact words were “I’m not worried about it”. His unwavering support and guidance were invaluable throughout the entire process. I am immensely grateful for Alex's exceptional legal representation and wholeheartedly recommend his services to anyone in need of a skilled criminal defense attorney. Alex Z is not just a lawyer; he is a beacon of hope for those navigating the complexities of the legal system. If you find yourself in need of a dedicated and competent legal advocate, look no further than Alex Z.
Taïko Beauty
Taïko Beauty
2024-03-15
I don’t know where to start, I can write a novel about this firm, but one thing I will say is that having my best interest was their main priority since the beginning of my case which was back in Winter 2019. Miss Claire Banks, one of the best Attorneys in the firm represented me very well and was very professional, respectful, and truthful. Not once did she leave me in the dark, in fact she presented all options and routes that could possibly be considered for my case and she reinsured me that no matter what I decided to do, her and the team will have my back and that’s exactly what happened. Not only will I be liberated from this case, also, I will enjoy my freedom and continue to be a mother to my first born son and will have no restrictions with accomplishing my goals in life. Now that’s what I call victory!! I thank the Lord, My mother, Claire, and the Spodek team for standing by me and fighting with me. Words can’t describe how grateful I am to have the opportunity to work with this team. I’m very satisfied, very pleased with their performance, their hard work, and their diligence. Thank you team!
Anthony Williams
Anthony Williams
2024-03-12
Hey, how you guys doing? Good afternoon my name is Anthony Williams I just want to give a great shout out to the team of. Spodek law group. It is such a honor to use them and to use their assistance through this whole case from start to finish. They did everything that they said they was gonna do and if it ever comes down to it, if I ever have to use them again, hands-down they will be the first law office at the top of my list, thank you guys so much. It was a pleasure having you guys by my side so if you guys ever need them, do not hesitate to pick up the phone and give them a call.
Loveth Okpedo
Loveth Okpedo
2024-03-12
Very professional, very transparent, over all a great experience
Bee L
Bee L
2024-02-28
Amazing experience with Spodek! Very professional lawyers who take your case seriously. They treated me with respect, were always available, and answered any and all questions. They were able to help me very successfully and removed a huge stress. Highly recommend.
divesh patel
divesh patel
2024-02-24
I can't recommend Alex Zhik and Spodek Law Firm highly enough for their exceptional legal representation and personal mentorship. From the moment I engaged their services in October 2022, Alex took the time to understand my case thoroughly and provided guidance every step of the way. Alex's dedication to my case went above and beyond my expectations. His expertise, attention to detail, and commitment to achieving the best possible outcome were evident throughout the entire process. He took the time to mentor me, ensuring I understood the legal complexities involved to make informed decisions. Alex is the kind of guy you would want to have a beer with and has made a meaningful impact on me. I also want to acknowledge Todd Spodek, the leader of the firm, who played a crucial role in my case. His leadership and support bolstered the efforts of Alex, and his involvement highlighted the firm's commitment to excellence. Thanks to Alex Zhik and Todd Spodek, I achieved the outcome I desired, and I am incredibly grateful for their professionalism, expertise, and genuine care. If you're in need of legal representation, look no further than this outstanding team.

Requesting an Independent Medical Exam

In personal injury cases, requesting the court order the claimant undergo an independent medical exam (IME) by the defense’s doctor can provide useful opinions. The IME may find no objective signs of injury or disability, undermining claims of severe harm. Some states limit requesting an IME to once, so timing it strategically is important.

Presenting Evidence in Court

If a reasonable settlement cannot be reached, then the lawyer must build the strongest case possible demonstrating the claim fabrication. Present all evidence gathered during discovery that contradicts the claimant’s version of events or reveals lies stated under oath. Use medical experts to persuasively explain how the records and symptoms do not match the stated injuries. Point out where financial motive influenced exaggeration or faking of claims.

Arguing Against Damages

The defense lawyer should argue against the requested damages even if some legitimate injury occurred. For example, challenge the extent of disability claimed, especially if the claimant was observed performing activities that exceed stated limitations. Argue surveillance evidence demonstrating exaggerated impairment. Dispute the need for ongoing treatment or medications well beyond normal recovery periods.

Utilizing Legal Defenses

Certain legal defenses may also defeat fraudulent claims. For example, the statute of limitations may have expired before the claim was filed. In some cases, disproving just one key element of the claim makes the entire case fail. Arguing comparative negligence when the claimant’s own actions contributed to the incident can reduce damages.

 

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