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Medical Insurance Fraud

doctor's stethoscope

Medical insurance fraud costs consumers and insurers tens of billions of dollars each year, according to the National Health Care Anti-Fraud Association. It drives up premiums for consumers and subjects some patients to unnecessary treatments and procedures. Everyone can help fight this common type of fraud by being vigilant and speaking up if something doesn’t seem right.

How to Protect Yourself

In the unfortunate event you are injured in an accident and require medical treatment, review your medical bills thoroughly. Make sure the treatments you were billed for were the treatments you received. If not, notify your insurance company. Be wary of medical providers who direct patients to a specific attorney and vice versa – however the practice is common and may be legitimate. Sometimes referrals like these are made so that kickbacks between the two may take place, not for your benefit. It is also a good idea to trust your own doctor to avoid insurance fraud.

The Federal Bureau of Investigations offers these tips to avoid being victimized by medical fraud:

• Never sign blank insurance claim forms.
• Never give blanket authorization to bill for services rendered.
• Ask your medical providers what they will charge and what you will be expected to pay out-of-pocket.
• Carefully review your insurer’s explanation of benefits statements. Call your insurer and provider if you have questions.
• Do not do business with door-to-door or telephone salespeople who tell you that the medical equipment they want you to buy or rent will be “free to you.”
• Give your insurance/Medicare identification only to those who have provided you with medical services.
• Keep accurate records of all health care appointments.
• Know if your physician ordered equipment for you.

How to Recognize Fraud

The National Health Care Anti-Fraud Association lists several common types of fraud that consumers may encounter:

• Billing for services that were never rendered.
• Billing for more expensive services or procedures than were actually provided.
• Performing medically unnecessary services to drive up bills.
• Listing treatments that aren’t covered as medically necessary treatments that are covered.
• Falsifying a patient’s diagnosis to justify tests, surgeries or other procedures that aren’t medically necessary.
• Unbundling — billing each step of a procedure as if it were a separate procedure.

Report Your Suspicion

If you suspect medical fraud, homeowners insurance fraud, or auto insurance fraud please report it.