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Stay Legal! Avoiding Insurance Fraud

Everybody knows that the medical insurance trade is continually raising month-to-month premiums, and many feel this is unjust to you because the consumer. However, the medical insurance industry has had to battle rising medical insurance fraud. The amount of money spent on investigating and prosecuting fraud is then handed on to policyholders. Many individuals don’t perceive what health insurance fraud entails, though. With reports estimating medical health insurance fraud is a $30 billion to over $a hundred billion business per 12 months, the topic shouldn’t be taken lightly. Each medical insurance policyholder ought to understand what medical insurance fraud is and its consequences. By doing so, you’re extra able to recognize and fight fraud.

Medical health insurance fraud is typically defined as intentionally deceiving, misrepresenting, or concealing information to obtain benefits from the insurance company. Basically because of this you say that you just paid for sure medical procedures or bills out-of-pocket which you have not truly received, and you are submitting claims to the insurance firm to receive reimbursement. One other example of member fraud is to conceal pre-present conditions or to change medical documents in order that non-policyholders or ineligible members obtain medical advantages underneath your policy. Perhaps your sister doesn’t have insurance and needs medical attention. Having her use your identify and coverage to cover the bills is medical insurance fraud. When you may think that this is a small issue compared to your sister receiving treatment, it’s really very severe to your health insurance firm and business, and will end in fines and doable imprisonment in case your are caught.

Not only policyholders commit fraud, however providers (physicians, hospitals, etc.) do as well. Since physicians and hospitals bill the insurance firm for providers they supply for you, they’re also receiving reimbursement from the insurance company. When providers commit fraud, they may be billing the insurance coverage firm at greater charges for services rendered or they might invoice for companies you never received. In these circumstances, you will in all probability be asked to cooperate in the insurance company’s investigation.

One other sort of health insurance fraud that has developed recently targets the policyholder more than the insurance company. Schemes have developed where fake insurance coverage companies or agents signal unsuspecting clients for coverage at surprisingly low premium rates. They often act very like a regular insurance coverage company for the primary few months, paying for smaller medical claims like physicians visits. But upon getting a more severe medical situation that needs remedy, the insurance coverage company will disappear – along with the money you have got been paying in premiums.
The rule with medical health insurance fraud is very similar to that of any other rip-off: if a deal seems too good to be true, just bear in mind – it most likely is. Remember to be sincere in your dealings with medical insurance firms and expect the same within the return from these companies, as well as your well being care providers. Stay legal to keep away from fines and prison and to proceed receiving health insurance coverage.