As everybody aware, monthly premium for health insurance is getting higher and higher which make us the consumer the victim. Nevertheless this high premium is the effect a very high rate of health insurance fraud. The health insurance industry has been fighting continuously these fraud cases and has been spending a lot of money on investigation and prosecution, thus they try to gain back their losses by charging us high premiums, the policy owners.
Most of us do not understand or worst do not aware at all about health insurance fraud. Heath insurance fraud is one of the most serious cases of fraud which we as a policy owner must take it as serious matter. On top of that to go a bit deeper, a policy owner should realize what it really mean by health insurance fraud what it could cause, so we will not be part of the agenda.
What do we mean by Health insurance fraud? In easy word health insurance fraud can be explain as the activity of trying to cheat the insurance company by giving false cases or information in order to get the insurance benefits. For an example, you claim the insurance company for a reimbursement on a medical treatment expenses which you don’t do and provide fake document to support it.
Another example of good health insurance fraud is trying to get a non-policy holder to gain the same benefits as a policy holder by manipulating some fakes document. In case where sometime your beloved one like your sister need some medical intention and she did not have any insurance covered, most people will do this and consider it as small matter. In reality it will give a big implication to the insurance industry and the consumer and on top of that one can be jailed if caught doing so.
You will be surprise that not only policy owner that perform this health insurance fraud, another party that is capable of doing it is the service providers like clinics and hospitals. Let me explain how. Normally the insurance company will pay the charges that the clinics and hospital charged the policy owner for any service the policy owner go for. On top of that the clinics and hospital will also get some reimbursement from the insurance company. So here is where the health insurance fraud can happen. Clinics and hospital that have intention to make fraud, they will claim a higher value than they suppose to charge for their service to the insurance company. Or maybe they provide some fake document and claim for some service they actually did not perform.
People are getting more and more creative nowadays. All the tactics of health insurance fraud discuss earlier is now common and have been identified long ago. To explain more about the types of fraud, recently the industry had discovered a new way on how people trying to perform this health insurance fraud. Now the culprits are not targeting the insurance company anymore but the policy owner itself. There is now a syndicate where phony insurance company is form and trying to get customer which is desperate for insurance with a very low premium rates. At the beginning they jut operate like a normal insurance company, paying for small medical claim and so on. When things getting serious and policy owner need more expensive treatments, suddenly this company vanished with all your premiums money living you in despair.
The basic precaution for this kind of fraud is just a very basic common sense which we could apply. If an offer is too good to be true, there must be some fishy thing is going on and try not to get involved in this kind of offer. On the other we as the policy owner please be honest to our self and don’t cheat just to fulfill our needs. There is a lot more people who actually really need the money from the insurance company for major reason. It will also control the insurance industry by limiting the increase of the premium payments.
By Yazed Jamal
