Health Insurance Fraud And Abuse
| Even a developed and industrialized country like the United States is not free from health insurance fraud and abuse. |
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In fact, this insurance fraud costs the American healthcare billions of dollars each year. According to industry analysts, health insurance fraud and abuse in the US is close to $100 billion a year.
There are different types of health insurance fraud and abuse. However, the most common one is intentional misrepresentation that results in unauthorized benefits. Abuse in health insurance involves charging for services that are not required medically or do not conform to normal medical standards.
It has been seen that false claims are the most common when it comes to health insurance fraud. Here the objective is to get payment for something that is not done. Such schemes include the following:
- Billing for services, procedures or supplies that were not provided
- Misrepresentation of what given to the patient; the condition of the patient; or the identity of the recipient
- Providing unnecessary services or ordering tests are that not required
However, insurance companies are now being hit by these frauds and they are carefully beginning to monitor the type of services being given to patients. Sometimes, companies are also resorting to checks and some of these checks have become rather controversial.
This said, health insurance fraud and abuse is not just done by the healthcare provider. Even patients are, at times, in collusion with the doctors and this is what makes it very difficult to establish a foolproof checking system. But insurance companies are now reviewing whether a hospital admission for a condition was necessary and then they review the care provided. If everything is in order, the claim is being paid or else it is denied.
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