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Insurance Fraud

Kundenfrage

I am living in Stuttgart Germany and am insured by Bupa International health insurance in Brighton England. I recently was operated on Munich for a slipped disc and a nasal septum deviation in a private clinic in Munich. After receiving the accounts I settled them directly with the provider and then forwarded them onto Bupa in England. However the problem is the following... I was diagnosed with a dissociative disorder ( a form of split personality) in 2004/2005 which was successfully treated with 9 weeks inpatient treatment in a neurological/psychiatric clinic and 2 years of outpatient treatment. One of the biggest things which was necessary to avoid is was stress. I have lately been under major family stress and health stress as my spine is not getting better and it may cause me not able to continue working. I realised on Thursday last week that one of these personalities as flared up. The accounts from the clinic where sent to Bupa Insurance, however from the look of things they were a new set of accounts which I had fabricated on my own PC with exaggerated amounts for the operations. On Thursday Bupa informed me that they would be checking the accounts directly with the clinic, as this is normal procedures for high amount claims. I only realised that I must have changed the accounts after I had spoken to the clinic on Thursday after talking to the clinic with hope of getting them to confirm the accounts in writing a little quicker. After looking into my PC I noticed that the set of accounts which I fabricated are still saved. I at this point realised that I have a personality disorder again!!! I immediately contacted the clinic and asked them not to give any information out to Bupa but to issue me with a new set of accounts. I informed Bupa in writing that I wished them not to continue processing the claim and not to settle the claims with me. I also informed them that I would be sending them with a new set of accounts directly from the hospital. I informed them that a mistake had been made and I wished it to be rectified first before further payment be made. My problem that I have, is it looks of course like fraud and I am worried that when I send Bupa the new accounts they will see the difference and take the matter further. Furthermore after realising my problem I started taking my tablets again from 2004/2005 and have also made an appointment at my psychiatrist and therapist again. Can you advise my next step?
Gepostet: vor 6 Jahren.
Kategorie: Strafrecht
Experte:  troesemeier hat geantwortet vor 6 Jahren.
Dear questioner,

with pleasure I take on your question as follows stand:

Changing the calculations shows a document forgery in action unity with tried deception. As far as the health insurance refunds here an announcement against you, you must count on preliminary proceedings and if necessary on a penal procedure.

On account of your illness you can plead for decreased debt ability. Hence, they should proceed fast again in therapy, so that your health state can be documented in a contemporary way.

If you are not previously convicted because of deception up to now, you can count in case of a conviction probably still on a fine, at most with a proving punishment.

They should proceed in case of a charge against you immediately in the representation of a lawyer on site.

I hope, I could get you the first orientation.
Kunde: hat geantwortet vor 6 Jahren.

As the insurance company is based in England and I am living in Germany, would they still continue with criminal procedures?

 

Does it not make difference, because I stopped that processing of the claim before it went further? It was actually not processed completly and no money was paid to me?

Experte:  troesemeier hat geantwortet vor 6 Jahren.
Because the assurance has her seat in England, you can be to good hope that this no charge will refund against you. However, it cannot be excluded that a charge occurs.

It was right and well that you have got in touch here with the hospital and with the assurance and have stopped with it the completion of the action. However, there remains with the attempt of the deception if one could prove this to you.

Try to realise a purification together with the hospital. Only if it comes to an announcement, you should absolutely visit a lawyer.
Kunde: hat geantwortet vor 6 Jahren.

The new set of accounts will arrive shortly. Would you suggest that I do not send them to England and rather pay for the treatment out of my own bank account and inform the insurance that they do not need to pay the claim at all..... Would that be the safer solution. I could then try and submit the claims to the German AOK and perhaps they will settle the claims with me directly.

 

Would it be possbile for you to take the case on privately outside if the internet and perhaps have contact with the clinic to prevent them from talking with the insurance in England?

Experte:  troesemeier hat geantwortet vor 6 Jahren.
The surest solution would be actual to bear the costs of the treatment in the clinic independently and to release the assurance from the achievement.

Whether, however, the compulsory health insurance scheme takes over your treatment, I cannot say you. At short notice, however, they should recite so with the compulsory health insurance scheme.

Unfortunately, have removed I my professional seat very far from Stuttgart. Because my woman comes from Stuttgart, I can recommend you the following colleague:

Name: Robert Wild Rechtsanwalt
Street: Marienstr. 9
Postal address: 70178 Stuttgart
Telephone number: 0711 603396

I wish you a lot of success and still a nice Easter party.
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Kunde: hat geantwortet vor 6 Jahren.

Ok many thanks. I will accept this answer now! Have a good easter!

Experte:  troesemeier hat geantwortet vor 6 Jahren.
thank you !