Surprisingly enough the most common type of health insurance fraud comes from the health care providers themselves. Insurance fraud is considered to be any dishonest or fraudulent intent to obtain payment from an insurance company or an insured individual. Billions of dollars are lost in fraudulent claims every year.
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According to the U.S. Attorneys website there are health care fraud and abuse control programs and guidelines to prevent insurance fraud from happening. This program works towards preventing fraud from happening and reprimands those who try to take advantage of individuals and insurers.
Why does health insurance fraud occur?
The common theme behind people committing health insurance fraud is for profit. Insurance policies and contracts give both those who are insured and the medical providers opportunities to exploit the contract. Much of the time health insurance fraud is used to deplete the taxpayer funded programs such as Medicaid and Medicare.
Certain health care providers will take advantage of patients. Some of the scams that are most common are double billing by health care providers. Some doctors will even provide unneeded surgeries to patients in order to receive money from insurers.
Health care providers can also commit health insurance fraud and argue it’s in the best interest of their patients. Sometimes this can include billing insurance companies for different services than those that were actually performed. This is usually because those needed services were not covered by the insurance policy and patients couldn’t pay for it out of pocket.
The government programs, Medicaid and Medicare, most often fall victim to insurance fraud because they have a fee for service type of structure. Medical care professionals will bill the insurance company for more expensive treatments than those that were actually provided to the patient in order to receive more money.
What are some ways the government is trying to prevent health insurance fraud?
According to the Department of Insurance, Securities and Banking there are several ways to prevent fraud and abuse towards the taxpayer government programs. Law enforcement and fraud abuse programs are working to fight against fraud in the health insurance systems. They do this by analyzing data to find questionable activity. Government programs are looking for discrepancies in enrollments, benefits and health care costs that are related to Medicare and Medicaid health insurance policies.
What are some ways individuals can protect themselves against health insurance fraud?
Many of the people who are most susceptible to health insurance fraud are those who receive the government funded Medicare plans. Some of the ways individuals can protect themselves against fraudulent activity is to know what Medicare plans and the people who represent those plans can and can’t do when it comes to insurance.
It’s important to know that a health care provider can’t ask for your social security number, bank account number or any credit card information. Unsolicited emails cannot be sent to you for insurance purposes.
Those who represent Medicare cannot call you unless you give them permission to call you. Medicare cannot charge you fees for enrollment into the government plan. People who truly represent Medicare will not come to your home in order to help you enroll in the plan.
Another warning sign of fraud is to have health insurance agents offer you cash to join their plan. You also cannot be enrolled into a prescription drug plan over the phone unless the insured calls and asks to be enrolled.
Payment cannot be received over the internet or the phone. Any agent or company trying to sell you Medicare cannot try to sell you an unrelated product such as life insurance. Anyone who tries to sell you a plan or enroll you during a health fair or conference should not be trusted.
Someone who tries to talk to you about Medicaid while you are receiving health care in a hospital or exam room should be considered a fraud. Those that use sales or scare tactics to pressure you into joining Medicaid should not be trusted as well.
By using some common sense and researching recommended health insurance companies and programs before signing you could prevent hundreds to thousands of dollars from being stolen right from your pocket. Only sign on with a company or policy when you are ready to join and have educated yourself enough on the program.
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