Avoiding Insurance Fraud

The rule with health insurance fraud is much like that of any other scam: if a deal seems too good to be true, just remember - it probably is. Remember to be honest in your dealings with health insurance companies and expect the same in the return from these companies, as well as your health care providers. Stay legal to avoid fines and prison and to continue receiving health insurance coverage.

Health insurance fraud is typically defined as intentionally deceiving, misrepresenting, or concealing information to receive benefits from the insurance company. Perhaps your sister does not have insurance and needs medical attention. Having her use your name and policy to cover the expenses is health insurance fraud.

Not only policyholders commit fraud, but providers (physicians, hospitals, etc.) do as well. Since physicians and hospitals bill the insurance company for services they provide for you, they are also receiving reimbursement from the insurance company. When providers commit fraud, they may be billing the insurance company at higher rates for services rendered or they may bill for services you never received. In these cases, you will probably be asked to cooperate in the insurance company’s investigation.

Another type of health insurance fraud that has developed recently targets the policyholder more than the insurance company. Schemes have developed where fake insurance companies or agents sign unsuspecting customers for coverage at surprisingly low premium rates. They often act much like a regular insurance company for the first few months, paying for smaller medical claims like physicians visits. But once you have a more serious medical condition that needs treatment, the insurance company will disappear - along with the money you have been paying in premiums.

How To Avoid Health Insurance Scam

Health insurance scams are not easily spotted-liars may be trying to take advantage of your ignorance. Therefore, it is important to know all you can about health insurance before purchasing a plan. If someone calls your home and tries to sell you a form of health care or health insurance, take what knowledge you have and ask as many questions as you can think of. Any indication that this may be a fake insurer should be taken to the state insurance regulators for investigation. The current trend of scams is on the rise due to the large number of uninsured individuals compared to the rising cost of prescription drugs. There are ways to keep yourself safe from these con artists and still pay a reasonable premium.

Does a health insurance company seem to be offering a policy that is too good to be true? Victims of health insurance scams are usually those who go shopping around and find a great deal (and then find that in an emergency they are without insurance). There are no clear indicators of fraud unless you know what particular red flags to listen for during their sales pitch of their particular policy.

Con-artists are professionals at what they do because it’s often how they make their entire living. First, common scams include loopholes that make sure what they are selling is not actually insurance. This would mean it is a discount program of some sort. These scams may reach you by telephone, offering a discount to individuals who, for any reason, do not qualify for real insurance. Also be wary if an agent mentions their plan being “reinsured.” It is true that some legitimate insurance companies do have reinsurance to protect themselves, but it is never mentioned when trying to sell insurance to a customer.