Protecting Professionals from Insurance Bad Faith

Baratta, Russell & Baratta is nationally recognized as a leading advocate on behalf of medical providers who have been targeted by insurers with false accusations of “fraud”.  We have:

  • Obtained millions of dollars in settlements on behalf of doctors who have been defamed and damaged by insurers;
  • Forced insurers to pay interest and attorney’s fees after wrongful denials of payment for medical treatment provided;
  • Defended countless doctors and their employees from false accusations of fraud in state and federal courts, including the outright acquittal of a chiropractor criminally accused of fraud by one of the largest health insurance carriers in the country;
  • Advised medical providers across Pennsylvania and the rest of the country how to proactively protect themselves from unscrupulous insurers.

It is sad, but true, that being well-intentioned and doing good work is not enough to protect anyone, least of all doctors, from the mercenary search for profit engaged in by the insurance industry in America.

There is not, and never has been, a “health care crisis” in America.  However, over the past two decades there has developed a dire health insurance crisis affecting all of us.  The “crisis” is just the insurance industry’s desperation for profit.  As insurers have realized reduced returns on investments in the stock market, they have sought to maintain their obscene profit margins by using their claims departments as drivers of greater income.  This bad faith business model turns the whole concept of insurance on its head.  Rather than being the “Good Neighbors” or Good Hands” people they promise to be, insurers now treat every new claim as an effort to steal profit from them.  Rather than looking for reasons to pay claims as required by their insurance contracts, insurers now look for and actually invent reasons to deny claims.

The most obvious drain on profit associated with injury claims is the cost of medical care.  In order to drive down this expense, insurers have erected a complicated health care payment system which is virtually impossible to understand or navigate.  Not satisfied with this impediment, though, insurers everywhere have also adopted a business model of actually attacking doctors who provide necessary and reasonable care and insist on getting paid for doing so.  Insurers call these doctors “frauds.”

The insurance companies know full well that merely making an accusation of fraud against a doctor is enough to destroy the doctor’s reputation and practice, especially now in our deeply connected world.  But even worse, the insurance companies know that their unlimited litigation budgets make their false accusations practically irrefutable.  Doctors of every specialty and size are potential victims of this financial terrorism.

If you are a medical provider who relies on insurance companies to reimburse you for the treatment you provide, there are measures you can (and must) take to prevent insurers from targeting you with a false accusation of “fraud”.  Some are simple and obvious like constructing and maintaining your treatment records and billing so as to make them bullet-proof from false accusations of fraud.  Others are more complicated, like preparing for and testifying effectively in support of your patients’ injury claims and your practice; marketing your practice appropriately; the proper delegation of treatment services to unlicensed staff; and many more.

No one better understands how to stand up to and stop insurers from hurting people than Baratta, Russell & Baratta.