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Health Insurance Fraud

Fraud happens for a variety of reasons. Unfortunately, especially with the proliferation of the internet, fraud has become more and more common over the years. Today, it’s almost certain that you’ll end up brushing against a type of fraud at some point. However, the type of fraud that you end up brushing against may be surprisingly different for every individual.

There are many different types of fraud out there. For example, someone may do identity fraud to try and present themselves as someone they’re not. They may also do financial fraud, claiming that they have money they don’t. However, one element of fraud you may never have thought about is health insurance fraud.

What is Health Insurance Fraud?

Essentially, health insurance fraud exists any time an individual, a doctor, or a health insurance agency misrepresents some element of health coverage to unfairly benefit an individual in the situation. The setup is supposed to be that the individual with coverage pays the health insurance agency a specific amount yearly. Then when the individual needs health coverage, they go to the doctor, and the doctor bills the health insurance company for any medical expenses they accrued. If anyone in this equation misrepresents themselves, it’s health insurance fraud.

How does Health Insurance Fraud Happen?

So what are some of the ways in which health insurance fraud can actually happen in a real-life situation? These are a few of the different ways that someone might misrepresent themselves to cause insurance fraud to exist:

  • Someone using illegitimate health insurance
  • A health provider billing for non-provided services
  • A health provider using the incorrect billing code
  • A health provider offering unnecessary services for a higher bill
  • A health provider not providing the appropriate care to bill higher

As you can see, both the individual and the doctor can commit health insurance fraud. That means it’s important to be on the lookout for health insurance fraud from the doctor as well. Though many people look for fraud mostly from the patient, doctors are also able to perpetrate fraud.

What Consequences Can Come from Health Insurance Fraud?

If someone perpetrates fraud, they can end up with serious consequences because health insurance fraud is a crime. The consequences can range wildly, and it depends on what you did, how you misrepresented yourself, and whether you may be guilty of malpractice. These are all possible consequences for health insurance fraud:

  • Fines
  • Probation
  • Community service
  • License revocation
  • Jail time

Discovering and rooting out health insurance fraud is an important part of making sure that insurance companies, doctors, and individuals all get the appropriate things out of the process. It’s an important portion of double-checking all elements of the health insurance process.

How can Enformion Help your Organization Discover Health Insurance Fraud?

Especially if you work for a health insurance company, you want to make sure that all health insurance connections are above ground. Working for a health insurance company, there are a variety of ways to discover health insurance fraud, but double-checking and cross-referencing is a crucial part of it. Enformion provides a huge database of information that allows you to make sure the people who you’re talking to are the real people you’re looking for, and also makes it easier for you to get in touch with people whose contact information you might not have from the beginning.