Health Insurance Fraud Types Impact & How To Stop It
The following is a list of the most common types of fraud.
* Filing a claim for treatment or service that was never given. This is often done by forging real patient information and making admissions with the help of service providers. * Increasing the overall expense of hospitalization by include procedures that were not medically essential. * Misrepresenting non-covered procedures as medically required. * Non-disclosure of Pre-Existing Diseases and making up diagnosis reports to justify tests, examinations, and surgeries to show that a claim is worth pursuing.
How to keep yourself safe : As a consumer, you have a lot of rights and can do a lot of things to protect yourself from scams in the health insurance industry. You also need know how to protect your identity.
Determine the Reputability of a Company or Agent
There are several ways to tell if a health insurance company is legitimate:
* Explore plans on the Marketplace
, So that you can learn more about the types of insurance companies that are out there. It's a good idea to look for signs that a company is trustworthy, like websites that end in ".gov," which means they are linked to a government agency.
* Check to see if an insurance firm is authorized to operate in your state.
The National Health Care Anti-Fraud Association's website is a good place to start. * Be wary of unsolicited calls.
Insurance companies will never try to get personal information from you, like your credit card number or social security number, on your own. *
Inquire about contact details. A trustworthy insurance company would have an easily accessible phone number where you may reach a company representative or agent. Try calling the number—if it doesn't work or it's really difficult to speak with a real, live person, it could be a hint that the company should not be trusted. *
Stay alert. If an offer sounds too good to be true, know that it is likely to be true. Know Your Rights - You have more rights as a consumer than you may realize. If you buy insurance through www.healthcare.gov, for example, you'll get a free, trained assistor who can provide you state-specific coverage information. You also have the option of never giving out personal information over the phone. Request that the corporation or agency requesting the information give you an official letter in the mail instead.
How to Complain About Fraud A fraud report number for your own health insurance company is the best place to start if you suspect that someone else is committing fraud, the FBI says. There are two ways you can report Medicare fraud: You can call 1-800-HHS-TIPS (1-800-447-8477) or go to Medicare.gov. Second, go to the NCHAA website and look for your state. Then, file a complaint with your state's fraud bureau. Besides that, file a complaint with the medical board in your state. Using the Complaint Assistant on the FTC's website, you can report a suspected case of identity theft. If someone steals your personal information, you can do this online. In addition, call the police in your area. You can also call the call centre for the Health Insurance Marketplace at 1-800-318-2596 (TTY: 1-855-889-4325) for help.
When Should You Take Legal Action?
According to the Coalition Against Insurance Fraud, in some situations, civil proceedings can convey a powerful message and aid in the prevention of insurance fraud. If you are considering legal action, consult with an attorney and a representative from your insurance company.