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Health insurance fraud is a very tricky subject and one that you must handle with care. Handle health insurance fraud with help from an attorney in this free video clip.
As defined by the Iowa Insurance Division, health insurance fraud is when a party knowingly submits false information to a health insurance company, such as a fictitious claim, so as to receive a payout that is undeserved. People who engage in health insurance fraud generally do so for financial gain, costing insurance companies billions of dollars each year.
Health insurance fraud is considered a major crime by both the federal government and state governments. Individuals, medical providers and insurance companies are all capable of committing the crime. In most states, health insurance fraud is considered a felony. Those found guilty of insurance fraud are tried on both the state and federal level, and are subject to fines, imprisonment and forfeiture of assets.
Incidents of health insurance fraud continue to present an expensive problem in the health care industry, one that costs patients and physicians alike. Detecting and deterring fraud is an extremely difficult task to accomplish due to the massive volume of claims received daily by insurance carriers, and because of the multiple types of fraud. According to the Coalition Against Insurance Fraud, more than three percent, or nearly $68 billion, of the $2 trillion spent annually on health care is lost to fraud.
Instances of health insurance fraud committed by patients continue to be a growing concern, costing millions of dollars annually and contributing to the rise in medical insurance premiums. In addition to these financial burdens placed on both insurance carriers and their customers, these crimes pose safety risks to both the legitimately insured patient and the fraudulent one.
Health care fraud and abuse are widespread, and they are costly to the American health care system. Health care fraud takes place when someone attempts to receive a benefit by intentionally deceiving an insurer or by misrepresenting a medical condition, such as when someone bills for a service that was never received. Fraud also occurs when a health care provider charges for services that are not necessary or that do not conform to professional standards, or when prices for services are at unfair levels. Abuse is similar to fraud, except that it is impossible to establish that the abusive actions…
Health insurance claim fraud is the process in which a medical provider bills for services that were never delivered or received. It's a way for medical providers to dishonestly increase their payment. Health care fraud accounts for nearly $70 billion of all health care spending in the United States. It's big business for unscrupulous providers that translates to higher premium payments for consumers.
In the United States, more than $2 trillion is spent on health care every year. The National Health Care Anti-Fraud Association (NHCAA) estimates that about $60 billion of what is spent on health care each year is lost to fraud.
