Swindling is one of the biggest issues which the self centered civilization has given rise to. There are plenty of such white collar crooks; those who do it successfully keep it doing and those who cannot, pay back in their own coin. Perhaps, it does not necessarily keep us shielded all the time and health insurance frauds could be pertinent example of this.
No doubt health insurance fraud is criminal offense. People, when intentionally report fake and/or deceptive information to get benefited from medical services that are not supplied or availed is called as health insurance fraud. They are not only consumers who initiate frauds; in many cases even medical services providers were found involved. Most repeatedly seen frauds in health insurance segment are listed beneath.
- Putting pre-existing conditions out of sight.
- Claiming for services those are not actually provided or availed.
- Manipulating records or validating needless medical treatments and operations to claim high.
- Not insisting on co-payments and deductibles.
- Misuse of insurance cover of one to tender treatment to someone else.
- Altering enrollment form.
- Adding ineligible dependents.
- Pointless prescriptions those subsequently turn into selling drugs in black market.
There are many such fiddles that can be spotted within entire health-care system. It is guesstimated that medical providers are highly crooks with high ‘fraud’ expertise sharing just about 80% of overall frauds, as compared to that of 10% by policyholders, and the rest by insurance carriers and/or their personnel altogether.
Multi-faceted reform strengthening anti-fraud mission could turn out to be an effective line of attack to shield the system. In this regard the Health Insurance Portability and Accountability Act known as HIPAA is been instituted since 1996 citing health insurance fraud as a federal crime that may result in imprisonment up to 10 years and heavy financial fine.