Company sent false claims to my insurance “to lower your deductible incase you want to work with us” is this legal?

So basically I had a 5 minute phone call consultation with a sleep center 2 weeks ago. They let me know the prices for a home sleep study and I told them I had to think about it and would contact them if I decided to move forward. Today I looked at my insurance app and saw it said I owe $1300 in claims. I was very confused seeing as how my insurance completely covers the only 2 things I use it for. When I looked at it I had about 5 different claims totaling $1300 for things such as “EEG” “brain wave test” “sleep study” “doctor visit” “doctor visit 60+ minutes” I didn’t think there was any correlation to the 5 minute phone call I’d had with the sleep center two weeks prior because 1. Id very obviously had none of that done. And 2. The claims were stating that it was from January 7th -27th.

I called my insurance they said they’d void the claims, later they called me back and told me I had to contact them myself. So I did, the man basically told me they did send those claims and said “if anything we were trying to help you by lowering your deductible in case you want to move forward with us in the future” he sounded annoyed and said that he can void it but again said he was just trying to help me out. Is this even legal?

Jobadvisor:

This situation raises serious concerns about potential insurance fraud. Here's a breakdown of the legal and ethical issues:

What the Sleep Center Did:

• False Claims: The sleep center submitted claims to your insurance company for services that were never rendered. This is a clear misrepresentation of facts.   
• Intent to Deceive: Their explanation, "trying to help you by lowering your deductible," suggests an intent to manipulate the insurance system for their potential benefit. Even if they had intended to void the claims later, the initial action of submitting them was fraudulent.
• Unauthorized Billing: They billed your insurance without your consent for services you did not receive.

Legal Implications:

• Insurance Fraud: Submitting false claims to an insurance company is a crime in most jurisdictions. It can lead to criminal charges, fines, and even imprisonment.   
• False Claims Act: Depending on the specific laws in your state, the sleep center's actions may violate state-level False Claims Acts, which are designed to protect against fraud against insurance companies.
• Civil Liability: You may have grounds for a civil lawsuit against the sleep center for damages, including any potential harm to your credit or insurance record.
• HIPAA Violations: Depending on the specific details of the information they submitted, they may have violated HIPAA laws by submitting false medical information.

Ethical Concerns:

• Breach of Trust: The sleep center violated the trust you placed in them by misrepresenting their services.
• Unethical Business Practices: Their actions demonstrate a disregard for ethical business practices and the law.

What You Should Do:

1. Document Everything: Keep detailed records of all conversations, dates, times, and the names of the people you spoke with. Save any emails or other written communication.
2. File a Complaint with Your Insurance Company: Insist that your insurance company thoroughly investigate the matter. They have a vested interest in preventing insurance fraud.   
3. File a Complaint with the State Insurance Department: Your state's insurance department regulates insurance companies and investigates complaints of fraud.   
4. Consider Filing a Police Report: If you believe the sleep center's actions constitute a crime, you can file a police report.
5. Consult with an Attorney: An attorney specializing in insurance fraud or healthcare law can advise you on your legal rights and options.   
6. File a complaint with the Better Business Bureau: this can help to warn other potential clients.
7. Consider filing a complaint with the state medical board that licenses the sleep center.

Key Takeaway:

The sleep center's actions are highly questionable and potentially illegal. Their attempt to justify their actions by claiming they were "trying to help" is not a valid defense. It is crucial to protect your rights and report this incident to the appropriate authorities.