Everyone is aware that the health insurance business is constantly boosting monthly prices, which many believe is unfair to you, the consumer. However, the health insurance business has had to deal with rising levels of health insurance fraud. The costs of detecting and pursuing fraud are then passed on to policyholders. However, many consumers are unaware of what health insurance fraud involves. With estimates ranging from $30 billion to more than $100 billion each year, health insurance fraud is a serious issue. Every health insurance policyholder should be aware of the concept and consequences of health insurance fraud. This increases your ability to recognize and fight fraud.
In most cases, health insurance fraud is described as intentionally lying, misrepresenting, or hiding facts in order to obtain benefits from the insurance company. Essentially, you claim that you paid for specific medical treatments or charges out of pocket that you did not receive, and you are making claims to the insurance company for reimbursement. Another type of member fraud is concealing pre-existing diseases or falsifying medical records so that non-policyholders or ineligible members gain medical benefits under your policy. Perhaps your sister is uninsured and need medical treatment. It is health insurance fraud to have her use your name and coverage to settle the bills. While you may believe that this is a small issue in compared to your sister having treatment, it is not.It is truly quite serious for your health insurance company and industry, and if you are detected, you may pay a penalty and perhaps imprisonment.
Not just policyholders, but also providers (physicians, hospitals, and so forth) commit fraud. Physicians and hospitals receive money from insurance companies because they bill the insurance company for the services they perform for you. When providers commit fraud, they may overcharge the insurance company for services delivered or bill for services you never got. In these circumstances, you will almost certainly be requested to assist the insurance company’s investigation.
A newer kind of health insurance fraud focuses its efforts on the policyholder rather than the insurance provider. Fake insurance businesses or agents have surfaced to sign unwary individuals up for coverage at unexpectedly cheap premium prices. For the first few months, they frequently behave similarly to a traditional insurance company, paying for minor medical claims such as doctor visits. However, if you develop a more serious medical condition that requires treatment, the insurance company will vanish, as will the money you have been paying in premiums.
The premise for health insurance fraud is the same as it is for any other scam: if an offer appears too good to be true, it generally is. Remember to be truthful in your contacts with health insurance companies and to demand the same from them and your health care providers. Stay legal to avoid fines and prison time and to keep your health insurance coverage.
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