Essays: Insurance and Health Care Fraud

Fraudulent Claims False insurance claims are insurance claims filed with the intent to defraud insurance provider. Insurance fraud occurs when any act is committed with the intent to claim fraud to obtain some benefit or advantage. Fraudulent claims account for a significant portion of all claims received by insurers, and cost billions of dollars annually. People claim insurance fraud on every and anything home, car, health, and even life insurance. Insurance fraud has existed ever since the beginning of insurance. Insurance fraud can be classified into two types hard fraud and soft fraud. Hard fraud occurs when someone deliberately plans or invents a loss, such as a collision, auto theft, or fire that is covered by their insurance policy in order to receive payment for damages that may or may not be real. Criminal rings are sometimes involved in hard fraud schemes that can steal millions of dollars. Soft fraud, which is far more common than hard fraud. This type of fraud consists of policyholders exaggerating otherwise legitimate claims. The U.S. spends more than $2 trillion on healthcare annually. At least three percent of that spending or $68 billion is lost to fraud each year. Fraud accounts for 19 percent of the $600 billion to $800 billion in waste in the U.S. healthcare system annually. Fraud amounts to between $125 billion and $175 billion annually, including everything from bogus Medicare claims to kickbacks for worthless treatments and other services. More than $2.4 billion in recoveries for fraud, waste and abuse in federal healthcare programs are expected for the first half of FY 2009 October 2008 through March 2009. Some 1,415 individuals and organizations also were excluded from federal programs for fraud abuse; 293 criminal actions were brought, as were 243 civil actions. In fact, state insurance departments shut down several health plans that were selling unlicensed coverage in 2008 and 2009. This suggests a resurgence of bogus health plans targeting small businesses and consumers, exploiting the economic uncertainty of the recession. Health insurance Fraud is number one in insurance fraud and Fraudulent claims. Fraud can be committed by both a member and a provider. Member fraud consists of ineligible members and/or dependents, alterations on enrollment forms, concealing pre-existing conditions, failure to report other coverage, prescription drug fraud, and failure to disclose claims that were a result of a work related injury. Independent practice who use false insurance claims and allow the insurance company or claimant to seek a non-partial medical view for injury related cases.
Some scams involve billing twice by doctors who charge insurers for treatments that never occurred, and surgeons who perform unnecessary surgery. There are many fraudulent claims going on each day all around the United States. South
Barrington surgeon sentenced in Medicare scam. A 63-year-old vascular and thoracic surgeon was sentenced today to 10 months in custody after being convicted of making false statements in post-operation reports

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Essays: Insurance and Health Care Fraud

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