Health Insurance Fraud and the Real Cost

Health insurance fraud is a felony offense in the United States of America. Anyone that is caught committing insurance fraud can be prosecuted and be sentenced to fines and jail time. It’s a very serious offense that cost policy holders and insurance companies billions of dollars each year. While the idea doesn’t seem that serious, the consequences of this fraud are very serious to the entire country.

What is Health Insurance Fraud?

The definition of health insurance fraud is varied but it’s very easy to understand. Health insurance fraud happens when someone intentionally deceives, misrepresents or conceals information to get benefits they are not normally entitled to. This type of fraud can be committed by doctors and patients as well as identity thieves. The problem with health insurance fraud isn’t limited to career criminals or people with horrible intentions. Some examples of fraud come from the best intentions but the result is still fraud.

Patients Committing Fraud

Some patients have good intentions and don’t think they are doing anything wrong when they begin committing acts of fraud. A friend may not have insurance but they need medications. Someone may go to the doctor for the same thing and continue to have prescriptions filled but are giving the medications away. This is an example of health insurance fraud. Another classic example of insurance fraud is allowing anyone except the policy holder to use insurance benefits. All these acts are illegal. And it shouldn’t be done.

It’s true that millions of people are without healthcare insurance. While they are without insurance, it’s not a reason to commit fraud. There are programs available for everyone to be seen and treated medically regardless to having insurance or not.

Doctors Committing Fraud

Doctors can commit healthcare fraud as well. There are many doctors that have been investigated, caught and prosecuted for billing insurance companies for procedures that never happened or charging more than the actual procedure actually costs. This can cost insurance companies millions of dollars in bogus charges before doctors are caught.

There is no reason for doctors to do this. The motivation for this kind of insurance fraud is normally greed. Many of these doctors want to increase their income or the income of their clinic and this is an easy way to do it. When medical bills or summaries come from a doctor’s office, many patients are too intimidated to question procedures they know they haven’t received because they don’t want to make their doctor angry.

The Cost of Fraud

Over the course of a year, one doctor can cost an insurance company millions of dollars in fraudulent claims. Depending on a patient, hundreds of thousands of dollars can be spent on someone that isn’t entitled to the benefits. Insurance companies have to recoup the money they are constantly spending on fraudulent claims, investigations and prosecutions. These companies get their money back by increasing the costs of healthcare insurance.

Every year millions of people complain about the rising costs of healthcare insurance. Healthcare insurance fraud is one of the reasons insurance companies are forced to increase the cost of their coverage. Medications are constantly rising, claims that have to be paid are increasing and along with that, cases of fraud are rising. This forces insurance companies to increase the cost of their coverage. While it doesn’t seem fair, companies will do what they can to soften their financial losses.

Instead of allowing fraud to happen, people should report the fraud they see happening. It’s costing insurance holders thousands of dollars each year they can’t always afford and insurance companies millions. It’s not fair the public has to pay such a steep cost for the greed of another. 

Jul. 2 14'
There are a lot of variables to your qeiotusn. The allowable amount of the procedure would hidge on the zip code where services are rendered, procedure codes billed and the contract with that paticular facility. Generally speaking the MRI companies bill somewhere in the range of $1200 per episode. The insurance company will leverage about $600-$900. If you are looking to get this done, I would suggest reaching out to a radiology facility versus doing this out-patient hospital. You are more likely to work a deal with the smaller facility then the monster hospital system. Call around you may get a better deal in the less populated areas of town. FYI- Keep in mind that the MRI itself is not the only charge A radiologist will often sneak a seperate bill in there for about $100-200.
Jul. 7 15'


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