Visitor Question

Sinus Surgery Insurance Fraud?

Submitted By: T (Cleveland, Ohio)

I went to a doctor and had sinus surgery. After not getting any better I went and got a second opinion from a new doctor. The new doctor looked at my CT scan prior to the first surgery and then looked at my sinus after the surgery. The new doctor said he could not see any difference from before and after the surgery!

I’m now wondering if the first doctor even did the surgery or just charged me and did nothing. What recourse do I have against the original doctor that packed my nose and charged my insurance company for the sinus surgery? Is this criminal fraud? What can I do? Thank you.

Disclaimer: Our response is not formal legal advice and does not create an attorney-client relationship. It is generic legal information based on the very limited information provided. Do not rely upon the information in our response, or anywhere else on this site, when deciding the proper course of a legal matter. Always get a personalized case review from a local attorney.


Dear T,

It appears the second doctor acknowledged surgery did occur. When he said to you he “could not see any difference from before and after the surgery” the implication was surgery did occur.

When you had the first surgery you no doubt had to recover. Your recovery period and its symptoms must have told you something was done to your sinuses. If surgery did take place you might not have the basis for fraud.

If the surgery was ineffective, a malpractice case would only be viable if there was proof the surgery was “botched,” or otherwise exacerbated your medical problem.

Seek the opinions of some other physicians. See if any of them can confirm your suspicions. If you are then satisfied your surgery was either never performed, or botched, your next step should be to contact several personal injury attorneys.

Any litigation against physicians is considered medical malpractice litigation. All medical malpractice cases should be pursued by qualified personal injury attorneys with experience in this specific area of law. Representing yourself would be ill-advised.

The above is general information. Laws change frequently, and across jurisdictions. You should get a personalized case evaluation from a licensed attorney. Find a local attorney to give you a free case review here , or call (888) 647-2490.

Best of luck,

Published: December 1, 2012

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