Stay Legal! Avoiding Insurance Fraud

Stay Legal! Avoiding Insurance Fraud



Stay Legal! Avoiding Insurance Fraud
Everyone knows that the​ health insurance industry is​ continually raising monthly premiums,​ and many feel this is​ unjust to​ you​ as​ the​ consumer. However,​ the​ health insurance industry has had to​ fight increasing health insurance fraud. the​ amount of​ money spent on​ investigating and prosecuting fraud is​ then passed on​ to​ policyholders. Many people do not understand what health insurance fraud entails,​ though. With reports estimating health insurance fraud is​ a​ $30 billion to​ over $100 billion industry per year,​ the​ topic should not be taken lightly. Every health insurance policyholder should understand what health insurance fraud is​ and its consequences. By doing so,​ you​ are more able to​ recognize and fight fraud.
Health insurance fraud is​ typically defined as​ intentionally deceiving,​ misrepresenting,​ or​ concealing information to​ receive benefits from the​ insurance company. Essentially this means that you​ assert that you​ paid for certain medical procedures or​ expenses outofpocket which you​ have not actually received,​ and you​ are submitting claims to​ the​ insurance company to​ receive reimbursement. Another example of​ member fraud is​ to​ conceal preexisting conditions or​ to​ alter medical documents so that nonpolicyholders or​ ineligible members receive medical benefits under your policy. Perhaps your sister does not have insurance and needs medical attention. Having her use your name and policy to​ cover the​ expenses is​ health insurance fraud. While you​ may think that this is​ a​ small issue in​ comparison to​ your sister receiving treatment,​ it​ is​ actually very serious to​ your health insurance company and industry,​ and will result in​ fines and possible imprisonment if​ your are caught.
Not only policyholders commit fraud,​ but providers physicians,​ hospitals,​ etc. do as​ well. Since physicians and hospitals bill the​ insurance company for services they provide for you,​ they are also receiving reimbursement from the​ insurance company. When providers commit fraud,​ they may be billing the​ insurance company at​ higher rates for services rendered or​ they may bill for services you​ never received. in​ these cases,​ you​ will probably be asked to​ cooperate in​ the​ insurance companys investigation.
Another type of​ health insurance fraud that has developed recently targets the​ policyholder more than the​ insurance company. Schemes have developed where fake insurance companies or​ agents sign unsuspecting customers for coverage at​ surprisingly low premium rates. They often act much like a​ regular insurance company for the​ first few months,​ paying for smaller medical claims like physicians visits. But once you​ have a​ more serious medical condition that needs treatment,​ the​ insurance company will disappear along with the​ money you​ have been paying in​ premiums.
The rule with health insurance fraud is​ much like that of​ any other scam if​ a​ deal seems too good to​ be true,​ just remember it​ probably is. Remember to​ be honest in​ your dealings with health insurance companies and expect the​ same in​ the​ return from these companies,​ as​ well as​ your health care providers. Stay legal to​ avoid fines and prison and to​ continue receiving health insurance coverage.




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