AUBURN – A local neurosurgeon is denying a lawsuit’s claim that he cheated a Massachusetts health insurance carrier out of more than $85,000.
In the suit, filed in Androscoggin County Superior Court, Benefit Plan Management alleges that Dr. Joel Franck submitted claims for services he never provided, double-billed for some services and “unbundled” others that should have been billed as a package for a cheaper price.
The suit also says that Franck submitted claims for services that were not covered under the plan, and the agency “inadvertently” overpaid him.
The claims were submitted this year and last, the suit says.
Based in Norwell, Mass., the agency claims that Franck’s billing manager admitted this spring to collecting the overpayments, but that Franck has refused to give the money back.
Franck denies the allegations.
His lawyer, David Sherman of Portland, said Franck was paid the exact amount that he should have been paid for each claim.
“He performed a certain procedure. A code was assigned to each one. They were submitted to the carrier, and they were paid,” Sherman said. “They were absolutely not throwing things in there that they didn’t do.”
Not only does Franck deny submitting false claims, he also doesn’t agree that the insurance company made the mistake of paying him for uncovered services, Sherman added.
The lawsuit is the latest problem facing Franck.
A neurosurgeon who has worked in Lewiston for nearly 20 years, Franck is also at risk of losing his medical license over two unrelated complaints filed with the Maine Board of Licensure in Medicine.
The complaints accuse Franck of incompetence and inappropriate conduct, according to Randal Manning, executive director of the state board.
One complaint was filed by a citizen and the other was filed by the licensing board itself, Manning said.
Details of the complaints will not become public until about a month before Franck’s hearing. The Maine attorney general’s office is in charge of scheduling the hearing, and Manning had no idea when it might happen.
An independent surgeon who has worked at both Central Maine Medical Center and St. Mary’s Regional Medical Center, Franck is free to continue practicing until the hearing takes place. He currently runs a private practice on Campus Avenue in Lewiston.
Last May, Franck was arrested in Durham on charges of assault, terrorizing and criminal mischief, in connection with an alleged attack on a woman at her Webster Street home in Durham. The district attorney’s office dropped the charges weeks later when the woman recanted her story.
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