Examples of health insurance fraud

On Behalf of | Sep 3, 2019 | Health Insurance & Medicare Fraud |

Health insurance fraud costs Tennessee residents a lot of money because they end up paying for it through higher healthcare expenses and insurance premiums. Both healthcare workers and scammers are offenders of this type of fraud, and along with paying more, some victims also face harm due to this deceit.

According to the National Health Care Anti-Fraud Association, each year there are billions of dollars in loss due to health care fraud. One part of this is due to healthcare providers taking advantage of insurance benefits. A doctor may give an incorrect medical diagnosis so he or she can bill for more serious (and expensive) treatment and care. This false information is on the patient’s medical records, and the payments of these fake claims go towards the patient’s life-time insurance limits. Other common things a provider may do are:

  • Bill for procedures that did not occur
  • Provide services that are unnecessary in order to bill insurance
  • Bill for more expensive procedures than were actually done
  • Waive deductibles or co-pays
  • Accept kickbacks
  • Misrepresent treatments or procedures

The FBI discusses another way health care fraud occurs, and this is through medical identity theft. This happens when someone steals a patient’s insurance information and uses it fraudulently for reimbursement for services that the patient did not actually receive. A criminal may get this information from healthcare personnel, through an internet interaction with the patient, at a free health screening or by purchasing it.

Because health insurance fraud has serious consequences, the FBI works with numerous agencies to combat it. They use undercover operations, strike teams and coordinated initiatives to find perpetrators.