How to Handle Health Insurance Fraud

If you suspect insurance fraud, report this immediately. Several private and government agencies handle insurance fraud claims. The Coalition Against Insurance Fraud estimates that health care fraud alone cost taxpayers $54 billion a year. Another study done by the Rand Institute for Civil Justice estimates that one-third of those in an auto accident inflate the extent of their injuries, costing an estimated $18 billion to American taxpayers each year. If you suspect insurance fraud or other swindles within the insurance industry, you can report it using this guide.

Difficulty: Easy

Instructions

1. Contact the insurance company directly to report insurance fraud. You may report insurance fraud to a number of agencies, but it is critical that the insurance company knows this first, so it can avoid financial losses and a host of other critical pitfalls. Reporting fraud to other agencies may take time, and in that time more abuse could take place, so notify the insurance company first.

2. Call the National Insurance Crime Bureau hotline. For insurance fraud occurring in or relating to auto insurance, workers' compensation, liability, and homeowners insurance, contact the NICB at 1-800-835-6422 or use the Resource box for more information.

3. Report suspected Medicare to the fraud hotline. Have the client's name, date of service, amount swindled, healthcare provider, and insurance number ready. You can report this anonymously or give the operator your information as well. A description of the acts that you suspect involves fraud or abuse relating to your allegation.

4. Contact your state directly for Medicaid fraud. Call 1-800-HHS-TIPS. Some states offer a monetary reward of up to 30 percent of recovered money from fraud claims.

5. File a complaint in your state's insurance regulatory department. You can file a complaint online. Use the Resource box for more information.

6. Report a doctor to their appropriate medical board. If you think your doctor may abuse insurance, contact the medical board that oversees his practice area, such as the medical, dental, or chiropractic board. Use the Resource box for more information.

Tips & Warnings

• You may report anonymously to the agencies, but it is more helpful if you give your information. Ask for confidentiality. The Journal of the American Medical Association report that health is in danger, insurance premiums stay high, health endangered, cost of goods increase, and workers lose jobs. Insurance fraud hurts everyone. Report the suspicion, even if you only suspect it.
• Some insurance companies ignore some suspected fraud, to avoid multimillion-dollar lawsuits. State and industry agencies that handle insurance fraud do not ignore insurance fraud claims. If you do not get an appropriate response or resolution from the insurance company, report it to the federal, state, or industry agencies to handle your claim.

Resources

• Federation of State Medical Boards
• Federation of Chiropractic Licensing Boards
• Dental Board
• File a Complaint Online