While fraudulent health insurance claims only constitute a small percentage of the total claims made each year, they are costly enough that they affect all policyholders. Experts estimate that the total amount of financial losses because of this problem and health care fraud span into the tens of billions every year. Higher premiums are the result of health insurance fraud. Unfortunately, people with private and employer-sponsored insurance plans end up paying the price for the dishonesty of others.
Financial losses are only part of the problem.
When people receive inadequate care because of a health insurance scam, their health may slowly deteriorate or become worse quickly. Some people have even died because of improper care or a lack of care. Never assume this type of fraud is a victimless crime.
What Health Care Fraud Looks Like
Most health care fraud cases involve dishonest health care professionals. These dishonest individuals take advantage of the trust that people normally put in them because of the positions they hold. Since they have access to a wide variety of resources, they can devise endless number of schemes. In many cases, patients with Medicaid and Medicare are targets. Some of the most common types of fraud these dishonest medical professionals commit include the following: – Billing for treatments that were not completed or padding a bill with nonexistent services being added to services that were actually rendered. – Performing services or treatments that are not necessary and billing the insurer. – Using codes for more expensive services on the bill than the actual services that were performed. – Making a fake diagnosis to allow for ordering of surgeries, treatments, tests and other procedures that are billable to an insurance company. – Claiming that non-covered treatments or cosmetic surgeries are necessary to obtain insurance payments. – Taking incentives for patient referrals. – Billing for different steps involved in a procedure as separate charges instead of just billing for the procedure. – Billing the insurer too much or waiving copay amounts for dental and medical services.Health Insurance Fraud
Effects Of Health Care Fraud
Health care fraud is representing false information as truth. One of the most common schemes involves people exploiting patients by putting false details or diagnoses into their records. This can affect a person’s premium and individual health. If a person receives unnecessary treatment, there could be serious health risks. In one case, a doctor was giving unnecessary chemo to people who did not need it. One man who did not even have cancer died from too many treatments in a period of time. If the false diagnoses are not discovered, patients could go years receiving unnecessary treatments, taking medications they do not need and watching their heath deteriorate. It is important to have an accurate heath record.
Medical Identity Theft
Most people are aware of identity theft that involves their financial information. However, most people are not aware of medical identity theft. It works in a similar way. With medical identity theft, information is stolen to receive medical care or benefits. When a victim tries to use his or her benefits, they may be exhausted. Another negative effect is having information on a medical history report that is not accurate. There are many other risks involved with health care fraud and health insurance fraud. It is important to report confirmed or suspected fraud. Since it affects every policyholder’s premium, everyone should do their part to prevent and report fraud.