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Health Insurance Fraud-Don't Add To The Increasing Healthcare Costs

by albertarticle

Everyone knows that the health insurance industry is continually
raising monthly premiums, and many feel this is unjust to you as
the consumer. However, the health insurance industry has had to
fight increasing health insurance fraud. The amount of money
spent on investigating and prosecuting fraud is then passed on to
policyholders.

Many people do not understand what health insurance fraud
entails, though. With reports estimating health insurance fraud
is a $30 billion to over $100 billion industry per year, the
topic should not be taken lightly. Every health insurance
policyholder should understand what health insurance fraud is and
its consequences. By doing so, you are more able to recognize and
fight fraud.

Health insurance fraud is typically defined as intentionally
deceiving, misrepresenting, or concealing information to receive
benefits from the insurance company. Essentially this means that
you assert that you paid for certain medical procedures or
expenses out-of-pocket which you have not actually received, and
you are submitting claims to the insurance company to receive
reimbursement. Another example of member fraud is to conceal
pre-existing conditions or to alter medical documents so that
non-policyholders or ineligible members receive medical benefits
under your policy.

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. While you may think that this
is a small issue in comparison to your sister receiving
treatment, it is actually very serious to your health insurance
company and industry, and will result in fines and possible
imprisonment if your are caught.

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.

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.

We're a resource site for those looking for <a
href="http://www.what-it-is.com">insurance advice</a> or need <a
href="http://www.digital-empire.net">insurance tips</a>. Visit us
or check out our <a href="http://www.articleinternet.com">health
insurance</a> articles.

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