Medical Bills Am I liable for breach of contract between the physician and the creditor?

[Legato]

Jurisdiction

California

I had services performed by a healthcare provider and the healthcare provider was required to enter into a contract with the healthcare creditor with certain stipulations pertaining to providing the services as billed and promised. The physician was immediately paid in full by the health care credit provider. It was later determined after an investigation that the physician violated the agreement with the Healthcare creditor by misrepresenting the facts of the services rendered. The creditor has now billed the physician for violations in accordance with the agreement that he signed with them (the healthcare credit issuer).

The physician is now trying to hold me liable for the charges and penalties that he accrued by violating the agreement with the healthcare creditor. Does this physician have legal grounds to hold me liable?


In case its not clear he was paid in full for the service.
It was later determined he violated the agreement with the creditor and they have billed *him* for those violations as according to the contract he has with them.

He is trying to call those penalties "reversed charges" and is trying to say that I did not pay him in full. What recourse do I have?

 

[adjusterjack]

Whether or not you are liable for the charges depends on what you signed before the service was provided.

Did you get a copy?
Did you read it?
Did you understand?

Many of those documents often say that billing a third party is a courtesy and the patient is responsible for any charges not paid by the third party.

Before you insist that you didn't sign anything, think about all the forms you had to fill out and sign before you got the procedure. In my own experience there is always on in there about payment.

 

[army judge]

The physician is now trying to hold me liable for the charges and penalties that he accrued by violating the agreement with the healthcare creditor. Does this physician have legal grounds to hold me liable


He is trying to call those penalties "reversed charges" and is trying to say that I did not pay him in full.

What recourse do I have?

In case its not clear he was paid in full for the service.
It was later determined he violated the agreement with the creditor and they have billed *him* for those violations as according to the contract he has with them.

I DOUBT that someone OTHER than the perpetrator of a crime or tort can SUCCESSFULLY litigate a matter in which the perpetrator desires to require someone UNINVOLVED in her/his UNLAWFUL activities responsible for any fines, fees, or costs the perpetrator is required to pay as a result of her/his actions.

As @adjusterjack opined, if you signed a document AGREEING to pay for the charges that an insurer declines, that might be an issue for you.

HOWEVER, you might be able to overcome that IF you attack it the way the insurer did; by claiming the physician lied, didn't legally perform such services, or was barred from performing same pursuant to state law.

 

[Legato]

They agreed to accept Care Credit and entered into an agreement with them in regards to providing services as promised and not submitting false documents. They were paid in full at the onset and my end of the contract was fulfilled. Care Credit is now going after them due to the physician having broken the agreement/contract with Care Credit.

What would enable this doctor to classify whatever breach of contract he has committed with them as being a reversed charge? There was a dispute and it was found to be a quality issue, the dispute was closed and he was paid in full.

(I am guessing) after further investigation It was later determined that the services were not done as stated and that he breached the contract with Care Credit to provide services as stated. They are now engaged in litigation with him. I have not been contacted about this at all.

I am only just hearing of this because now because the doctor has sent me notice saying I did not pay him.

 

[Legato]

Great, thank you to both of you for your insights. Have a great day.

 

[zddoodah]

the healthcare provider was required to enter into a contract with the healthcare creditor with certain stipulations pertaining to providing the services as billed and promised.

Required by whom? What does "the healthcare creditor" mean?

The physician was immediately paid in full by the health care credit provider.

Ok...hold on...here's the cast of characters so far:

1. You
2. The healthcare provider (aka the physician)
3. The healthcare creditor
4. The health care credit provider

I'm not sure if 3 and 4 are supposed to be the same person/entity, but either way, it's not clear what you mean by those things.

It was later determined after an investigation that the physician violated the agreement with the Healthcare creditor by misrepresenting the facts of the services rendered.

Determined by whom? Who conducted this investigation?

Does this physician have legal grounds to hold me liable?

I haven't the slightest idea for the reasons explained above and because I have never read any agreements between you and any of the other players involved.

What recourse do I have?

Recourse for what? If someone wants money from you, you either pay it or you don't.

What would enable this doctor to classify whatever breach of contract he has committed with them as being a reversed charge?

The doctor needs to get paid, and you are ultimately responsible for paying. You shouldn't be liable for anything beyond the cost of your medical care.

 

[Legato]

Required by whom? What does "the healthcare creditor" mean?



Ok...hold on...here's the cast of characters so far:

1. You
2. The healthcare provider (aka the physician)
3. The healthcare creditor
4. The health care credit provider

I'm not sure if 3 and 4 are supposed to be the same person/entity, but either way, it's not clear what you mean by those things.



Determined by whom? Who conducted this investigation?



I haven't the slightest idea for the reasons explained above and because I have never read any agreements between you and any of the other players involved.



Recourse for what? If someone wants money from you, you either pay it or you don't.



The doctor needs to get paid, and you are ultimately responsible for paying. You shouldn't be liable for anything beyond the cost of your medical care.

I will try to make it clearer. There are 3 entities. The physician, me and the creditor. When the physician agrees to accept payment from this creditor it is akin to becoming a provider on their network. They create an account with the creditor and have an agreement with stipulations. He benefits from doing that because he can now get more patients, who look at the large provider list that the creditor works with and finds him as an available doctor who will accept their line of credit (can only be used for healthcare related services)

This is basically to make sure the physician plays according to the rules and as has happened in my case, the creditor can 'step in'. This is an added benefit for me in using this creditor.

What happened was there was a dispute between the doctor and myself. How it played out was that the doctor was paid in full by the creditor. However the creditor continued to investigate the claim, even though I was no longer a party to the action. The creditor is now claiming that the doctor misrepresented the services he provided and has now brought legal action against him for violating the agreement /contract he signed when he agreed to become "part of the network" and accept payment from this creditor.

So what I am asking here is that the doctor has now made the broad legal stretch/leap of "lumping" the penalties that the creditor is bringing against him into a "reversed charge" and is very broadly and in my opinion, illegally calling that a "reversed charge" from me. I am no longer involved. He got paid and withdrew the money from the account that he had with them and ran. Now basically due to his violation of the contract he has an account in bad standing with them (that he will just no longer use/accept etc) and they are going after him because t hey are now determining that he violated the agreement with "them" by misrepresenting the services he supposedly provided to me which was a violation of the contract /agreement that he had with *them* (the creditor) The fees and penalties that the doctor can accrue are many and they are just basic rules that they have to follow and they agreed to follow when they entered into the contract with the creditor (basically keeps the provider in line and is an added benefit for the patient in using this creditor) Basically they paid him and now whereas I would be banging my head against the wall going after him, they now go after him instead on their own behalf and I can rest easy. Again, this is a benefit for patients in using this creditor when or if something like this happens (in their determination)

So again, the doctor was paid, now the creditor is bringing action against the doctor (which is between them and him) and I am no longer involved. However the doctor is trying to bring me back into it and call whatever is going on between the creditor and him a "reversed charge'.



He was paid ($10,000+), he withdrew the money from the account that was created and he's now gone. Now they are making a claim against him because they have determined that he made misrepresentations in the services that were (supposedly) provided. This claim of course at this point is just an outstanding bill that they sent to him.

What would be the legal terminology for keeping me out of that since I am no longer a party to the action? At this point he is just making the claim that I didn't pay him like it was a charge back. But that isn't what happened. He isn't showing any documentation he's just saying he wasn't (his office manager is saying "the charges were reversed"). What it actually is is that he has an outstanding bill from the creditor for violating his agreement with them (and he is falsely calling that a charge back from me). They are saying that he broke the contract with them when he misrepresented the services that he stated he provided and as according to the contract he has with them, he has now accrued provider fees/charges in the amount of "X." He's saying X is actually a charge back from me.

Hope its clear, I didn't think it was that complicated but only 1 out of 3 respondents seem to understand what I am saying. It seems like this is a new type of business transaction with this type of health care credit provider so its understandable.

 

[adjusterjack]

You mentioned Care Credit earlier. I looked it up. It's a credit card. That means you borrow money from Care Credit and pay it back monthly with interest. When you charge the doctor's bill on the credit card, yes, Care Credit sends the money to the doctor and you owe Care Credit. That's how every credit card works.

For some reason Care Credit has clawed back the money from the doctor. That should have been credited to your credit card account. That means you no longer owe Care Credit, you owe the doctor.

I go to Walmart and buy $1000 worth of stuff and use my Visa Card. Visa sends $1000 to Walmart. I get a bill from Visa with the option of paying the $1000 in installments with interest.

For some reason, Visa charges back the $1000. It gets credited to my account. I no longer owe Visa but I certainly owe Walmart.

If you don't understand how Care Credit works, I suggest you go back to its website and study up. Also read your cardholder's agreement.

Bottom line, if Care Credit got the money back from the doctor, you owe the doctor.

 

[Legato]

Ar

Bottom line, if Care Credit got the money back from the doctor, you owe the doctor.

What if Care Credit has not got the money back from him? From my understanding I was the first customer to use an account with them. He was antsy about having the funds released to him "for the (service) they "performed" (even though it was in dispute at that point). If he got the money and has not returned it to Care Credit, doesn't that make me responsible to Care Credit and not him?

 

[adjusterjack]

. If he got the money and has not returned it to Care Credit, doesn't that make me responsible to Care Credit and not him?

That would be a reasonable conclusion. Are your credit card bills still showing a balance with no adjustment credits?

Answer these questions too:

What was the dispute about?
Did you file the dispute with the credit card company?
What date did you do it?