Health Insurance Fraud: How to Protect Yourself From Scams
Health insurance fraud is an ever-present danger in the healthcare and wellness sector. Scammers are continuously targeting individuals, businesses, and government programs to get their hands on financial data and use it to their advantage. Fortunately, Health 2.0 Conference highlighted a few ways to protect yourself from scams and take control of your healthcare in
- But before learning about preventive measures, let’s discuss health insurance fraud and its types.
Table of Contents
- 1 What Is Health Insurance Fraud?
- 2 Common Examples Of Fraud
- 3 Identity Theft:
- 4 Fee-Churning:
- 5 Unbundling:
- 6 Misrepresentation:
- 7 Double Billing:
- 8 Ways To Avoid Being A Victim Understand The Process
- 9 Deep Research
- 10 Reviewing And Resolving Issues
- 11 Review Your Policies
- 12 Keep Your Data Safe & Secure
- 13 Conclusion
What Is Health Insurance Fraud?
Health insurance fraud occurs when an individual or entity misrepresents the truth. Sometimes, they provide false information to get a larger payout from insurance companies, added Health
- These scammers can be individuals, companies, or even healthcare professionals that defraud insurers. They do this to receive high refunds for medical procedures, prescription drugs, and other medical services.
Common Examples Of Fraud
In the United States, insurance fraud costs insurers an estimated $30 to $40 billion annually. It’s a huge burden that is ultimately passed on to policyholders. The most common forms of health
insurance fraud include billing for services not rendered, overbilling, upcoding, and unnecessary referrals. In addition, there have been cases where individuals, organizations, or companies have engaged in fraudulent marketing schemes such as free health services not covered by health insurance.
Identity theft is among the most common types of insurance fraud. It involves criminals stealing an individual’s personal data to use it for insurance purposes. It includes filing false claims, changing existing accounts, or creating new accounts under someone else’s name.
Fee-churning is when a provider submits claims for already performed treatments and procedures. It is usually done to increase their payments from the insurer, highlights Health 2.0 Conference.
Unbundling is when a provider bills individual services and supplies rather than one service in order to increase the cost.
Misrepresentation is when providers deliberately lie or omit information to increase their payments. It involves altering or faking documents, falsifying records, or even billing for never performed services, addressed Health 2.0 Conference.
Double billing is when a provider bills the insurance company and the patient for the same service. This can happen unintentionally when a provider’s billing system has incorrect data.
Ways To Avoid Being A Victim Understand The Process
To avoid being a victim of health insurance fraud, it is advised to know about the process of filing claims. Before submitting a claim to your health insurance company, one should:
- Always review your paperwork thoroughly.
- Ensure that all information is accurate and complete.
- When getting services, take the time to check for overcharging, upcoding, and unnecessary referrals.
Additionally, it is wise to research providers. Also, ask for credentials before trusting them with your care. Finally, staying informed of current scams and new technology is essential. It can save you from being vulnerable to fraud. You can do this by attending a healthcare event in 2023, like the Health 2.0 Conference. You can plan to attend its upcoming editions in the USA and Dubai. It addresses all the concerns of the healthcare and wellness sector. Health 2.0
Conference aims to provide a platform to leaders to discuss possible solutions. This event hosts leaders from all over the world. So, you will get a comprehensive review of global healthcare and wellness problems and effective approaches.
Reviewing And Resolving Issues
Suppose you find errors on your insurance statement or feel like you’ve been the victim of fraud. Contact the insurance provider right away and dispute the charges, suggests Health 2.0
Conference. During this process, the insurance company will review the issue. They will attempt to resolve it in your favor. The insurance company may contact you for documentation or to provide more information about the dispute. These are measures you can take to save yourself from insurance fraud.
Review Your Policies
The best thing to do is to review your insurance policy and become familiar with the coverage. Check your billing statements for accuracy. In case you spot something that does not make sense, contact your insurance company right away.
Keep Your Data Safe & Secure
It is also essential to keep your personal information safe and secure. Never share your
insurance information with anyone, highlights Health 2.0 Conference. Make sure to update your
personal information. Inform your provider if there is any change in your address and phone number.
Insurance fraud is a severe problem and one that is unfortunately widespread in the United
States. Healthcare providers, insurers, and policyholders alike have an obligation to take steps to help prevent and identify fraud. They need to do what they can to report suspicious activity.
Doing so will help reduce the impact of healthcare insurance fraud, say experts at the Health 2.0 Conference. All this can ultimately save policyholders money in the long run.