What is Health Insurance Fraud?

Health insurance fraud

Health insurance fraud

Fraudulent behavior can be resolved within a health insurance context such as any behavior designed to request money that a person or group is not entitled to. There are so many types of health insurance fraud it would be difficult to name them all. This is especially the case because health insurance fraud perpetrates by a variety of sources, including health insurance companies, insurance brokers, unscrupulous doctors, chiropractors, ally health professionals, medical institutions, and patients.

Some examples of institutional or health education led health insurance fraud include forgery of information in forms. This is not always intended for the personal benefit of the healthcare professional or the institution. Sometimes, a doctor may omit information on forms that would lead a patient not to receive treatment due to an existing condition, or a hospital, will change the time of admission slightly so a patient is not charged for a full day. Although these actions are good sense, they are nevertheless false because they do not accurately report to the patient’s insurance company.

Intentional health insurance fraud

Intentional health insurance fraud

Intentional health insurance fraud does not even have this excuse to try to help a patient. Instead, doctors can ally healthcare professionals or hospitals file false claims, claim treatments for patients who never took place, fill out prescriptions under patient names, and then sell them on the black market, diagnose non-existent diseases, and order unnecessary trials. Occasionally, a medical worker is working in pursuit with a personal injury lawyer to forge medical reports, in which case more than one type of insurance fraud can be perpetuated.

Health insurance companies or brokers can also commit various forms of health insurance fraud. The largest of these is not paying for legitimate claims. Some companies must deliberately refuse payment in the hope that applicants will not protest the treatment. They may also refuse based on reasons that are unfounded or illegal, but may change their decisions if people want to investigate denial. Routine misleading information of the cover may fall under the health insurance fraud umbrella as well. When insurance representatives do not truthfully disclose information about what is covered, which can happen, they can deceive their clients by avoiding payment, or by preventing customers from getting treatments they need, which are really covered by their insurance.

Alternatively, some “health insurance companies” or “brokers” are not really legitimate and instead fraudsters are looking to make a quick buck on people who are desperate for health insurance. They have no intention of paying claims and just wanting to collect their money. An additional form of health insurance fraud is false allegations of what is being sold. For example, health discount schemes are not insurance. When represented as insurance, this can be a fraudulent act. Sale of insurance in a state where a company is not licensed to operate is fraud.

Finally, patients can commit health insurance fraud in a variety of contexts. They could make false claims about occupational diseases for a number of reasons. If an insurance company requires any kind of physical, and the patient does not provide accurate information, this may be considered fraud and may invalidate coverage. Also, patients who are willing participants in fraudulent acts of doctors or facilities that misreport information can be a feast of fraud and be prosecuted.

Natasha Hayes