Unveiling the Top Examples of Health Insurance Frauds in the US
Health insurance fraud has always been a rampant issue in the United States. Around $68 billion are lost annually because of fraudulent health claims. This problem affects both patients and insurance providers, but it’s the patients who are left with the most significant consequences. The growing number of health insurance fraud cases in the US has prompted us to research and illustrate the top examples of health insurance fraud.
What is Health Insurance Fraud?
Before discussing the top examples of health insurance fraud, it is essential to understand health insurance fraud. Health insurance fraud is the intentional and deceitful submission of a false claim to an insurance provider in order to obtain financial gain. Health insurance fraud is a criminal offense, punishable by significant fines and even imprisonment.
Top Examples of Health Insurance Fraud in the US
Falsification of Medical Records
Falsification of medical records is a common tactic used in health insurance fraud. It involves changing or altering medical records to support a fraudulent health claim. For example, a patient may alter their medical records to show that they had a particular treatment when they didn’t. This can result in false payments from insurance providers, which is a clear example of health insurance fraud.
Overbilling and Billing for Services Never Provided
Overbilling and billing for services never provided are another top example of health insurance fraud. For instance, providers may overbill for a service that was never performed. For example, a provider may bill for three chiropractic sessions, even though the patient only received two. This type of fraudulent activity is commonly done because insurance companies make payments based on the number of services provided.
Prescription Fraud
Prescription drug fraud is one of the most common health insurance fraud cases. It involves both patients and providers. Prescription fraud is the forging of prescriptions, trading prescription drugs, or using another person’s prescription medication. This is a severe offense and a violation of the law.
Unnecessary Medical Procedures
Performing unnecessary medical procedures is another common example of health insurance fraud. A healthcare provider may perform procedures that are not medically necessary for their patients. This is often done to increase their billings, and the inflated bill is then charged to the insurance company.
Fake Providers and Billing Companies
Last but not least, fake providers and billing companies are another top example of health insurance fraud. Fake providers and billing companies are created purely for the purpose of fraud. The fake billing companies collect health insurance information or create inflated claims. This type of fraud is often organized and can be challenging to detect, leading to significant losses for insurance providers.
Conclusion
Health insurance fraud is a prevalent issue in the United States. Patients and insurance providers lose billions of dollars annually due to fraudulent health claims. Falsification of medical records, overbilling, prescription fraud, unnecessary medical procedures and fake providers and billing companies are the top examples of health insurance fraud. It is essential to be vigilant and report any suspected fraud activity to prevent further losses.
