Examples of Health Insurance Fraud

Health insurance fraud is committed by health-care providers who file unscrupulous claims with insurance companies to profit financially.

Examples

Examples of health insurance fraud include false claim schemes, Medicare and Medicaid fraud, extravagant or improper medical testing or billing, billing for unperformed procedures, personal injury schemes, illegal coding, double billing, billing separately for procedures that should be billed as one and taking kickbacks.

Schemes

The health-care industry is wrought with fraudulent schemes. The most common ones include billing for services that were not provided or lying about what type of service was given, making extravagant claims based on wrong diagnoses and administering services or tests that aren't medically necessary.

Risks

Health insurance fraud puts patients at risk. Inaccurate or false diagnoses, wrong medical histories, unnecessary testing and medical identity theft all negatively impact a patient's well-being and his ability to file future claims.

Prevention

Health insurance ID cards should be kept safe. Suspected health insurance fraud should be reported, and patients should keep accurate health insurance records.

Anti-Fraud Programs

Large insurance companies have teamed up with the National Health Care Anti-Fraud Association and the Coalition Against Insurance Fraud to keep an eye on and combat fraudulent health insurance practices.

References

• Insurance Fraud and Abuse: A Very Serious Problem
• Medicare and Medicaid Fraud
• The Problem of Health Care Fraud

Resources

• Phony Health Insurance Scam Alert
• How to Report Health Insurance Fraud