health insurance billing fraud
health insurance billing fraud
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ID Theft 2.0: Surge of Unemployed, Uninsured Give Rise to Health Insurance Fraud
It all started with credit cards.
Remembering your PIN number in the check-out line was that industry’s Hail Mary Pass to cut losses from fraudulent purchases back in the mid-80s. Fingerprint and retinal scans were developed by the FBI about the same time to keep us out of secure areas and to keep our prying eyes off top-secret documents.
Now, fast forward about 20 or so years. Throw in a dismal economy, mix in thousands of suddenly uninsured Americans and you’ve got the makings of an apparently unforeseen black hole of security that could threaten the future of affordable healthcare and the efforts of Congress to reform it.
A woman in New York City faces up to seven years in prison on charges she recently forged more than 50 insurance claims that submitted them to her health insurance company for reimbursement. Meanwhile in Miami, a medical clinic for senior patients was raided after investigators discovered a front desk clerk sharing 1,100 Medicare IDs and patient information with her family members. One of her cousins allegedly made off with $2.8 million in fraudulent refunds for services never rendered.
“As more people are not getting the health care they need, we’re seeing an increasing incidence of medical identity fraud,” tells Michigan-based attorney Norbert Kugele to the New York Times. “Someone will show up at a hospital with someone else’s insurance information and will seek treatment under their name.”
Pulling a Fast One
It’s almost like the industry never saw it coming. Of course, Medicare fraud has been going on for years and the Feds have been battling it with great intensity, by their own admission, with mixed success. But security experts warn high profile health insurance fraud cases are only going to grow and there may be no end to creative tactics the perpetrators may use to bilk an already handicapped health system.
President Obama claims the healthcare reform bill being considered by Congress will provide a safety net to prevent illegal immigrants from obtaining health care under the “Public Option.” Just how this will happen is anybody’s guess. Many citizens who relocated to America without proper documentation have been receiving public benefits and/or employment opportunities for years without much scrutiny by business owners or infiltration by state and local governments — so much so that the Feds figure in fraud when making all kinds of budgetary projections to Congress.
Medical identity theft occurs when criminals obtain information such as a health insurance identification or Social Security number and use it to get health care or to obtain reimbursement from insurers and others for false claims. That means your medical history and health care records can include someone else’s information.
Aside from the obvious health concerns that go along with adopting someone else’s health profile, — imagine an ID thief at the doctor’s office, presenting a health insurance ID from a patient who, unbeknownst to the thief, is diabetic, allergic to certain medication or receiving chemotherapy — there are other huge expenses that could undercut any savings that the Obama administration projects would be saved by reform in its current form.
“Hospitals and insurance companies face enormous expenses when it comes to medical identity theft, as they are forced to write-off charges incurred by the thieves,” recently wrote Bankrate reporter Amy Crane. “But its victims find that the financial aspects of this type of identity theft are the easiest to deal with.”
What You Can Do
- Your Insurance Card, your life. Security experts think we too often assume that our insurance card is no more valuable than our frequent shopper card or our gym membership. Protect your insurance information as you would your credit card, driver license or other personal asset.
- Give your medical records a check-up. Audit your health insurance and medical records annually, as you would your personal credit report. It’s not only o.k. to ask your doctor for your medical records, it’s protected under federal law to do so. If you see anything that look suspicious, call your insurance company right away.
- Go paperless. Not only is it environmentally friendly, opting into paperless health insurance benefit and billing statements is a good way to prevent your personal health information from slipping into the wrong hands.
About the Author
What happens when a man is keeping his ex-wife on his health insurance plan and committing fraud?
The guy has been divorced for 3 years and keeping his ex-wife on his plan stating that they are married and she is his wife to get all of her medical expenses covered and they have amounted to a huge amount. Where would a person report this fraud and what would happen to the ex-husband and the ex-wife? Who would have to pay back the insurance company the monies paid out to the cover her bills?
fraud = jail time & fines!
