Your health is among life’s most valuable assets. We trust doctors and medical workers to look after us and ensure we stay well. When your medical information is used to commit fraud, it can impact your financial health. Additionally, an already strained health system is abused for nefarious purposes. We can protect ourselves and our community by knowing how to spot and prevent healthcare fraud.
What is Healthcare Fraud?
Healthcare fraud is a crime. It consists of using deception to obtain illegal benefits or payments. Patients, doctors, and medical providers can commit healthcare fraud. In a recent year, the U.S. spent $4.8 trillion on healthcare. The National Health Care Anti-Fraud Association estimates that annual financial losses due to fraud amount to at least 3 percent of that total, equating to tens of billions of dollars.
Recognize the Signs
By being aware of what healthcare fraud is and how it is committed, it can be easier to recognize the signs. Some of the most common forms of healthcare fraud include:
- Creating fake bills: A provider sends an invoice requesting payment for a procedure or treatment they never delivered.
- Lying about the patient’s actual state of health: A healthcare provider uses an insurance code corresponding to a condition worse than the patient has to gain a higher payment. This is also called “upcoding.”
- Getting kickbacks: A doctor or other practitioner receives financial incentives for referring patients to another hospital or doctor.
- Altering records to charge more: Using a tactic called “unbundling,” the provider lists each step of a procedure as a single treatment to bill the insurance provider for a higher price.
- Ordering medically unnecessary testing: Prescribing a battery of tests and scans that are medically unnecessary for financial gain.
- Using another’s insurance illegally: A patient or doctor fraudulently uses someone else’s healthcare ID to cover their costs.
Take Action to Prevent Fraud
Fraud prevention can save your own life and health from upset, but it will also help keep down healthcare costs for everyone. Here are some simple ways that you can take action to prevent fraud:
- Protect your health insurance ID: Your health insurance ID is comparable to a credit card. If someone steals it or records your information, the door is open for them to fraudulently bill your insurance. Don’t let this happen by keeping your card safe and secure. Do not share your card details with anyone you do not trust.
- Report suspicious activity: If you suspect your healthcare provider or doctor is committing fraud, call or email your insurance company’s fraud department to report the matter. Give as many specifics as possible so any illegal activity can be stopped.
- Stay informed about your treatment: Know what tests or treatments you are getting and why. Don’t be afraid to ask questions to understand. If you are informed, you will be able to see discrepancies in your bills or insurance statements if something is not as it should be.
- Understand your insurance policy: Read your policy and what it covers. Know your benefits and keep up to date with any notices you receive. If you discover your insurance is being charged for services you haven’t had, speak up. Please report it to the company and get the bad actors identified.
- Beware of healthcare scams: Promotions for “free” testing could be a cover to collect your health insurance ID illegally. Make sure the offer is legitimate or being provided in conjunction with a respected healthcare system before you give a provider your credentials.
Participate in International Fraud Awareness Week
Every November, organizations and individuals across the globe come together to celebrate Fraud Awareness Week. This public information effort seeks to minimize the impact of fraud worldwide through education. As a member of the public, you can participate in seminars, webinars, or free educational initiatives. Use this time to get inspired and learn more to protect yourself and others from fraud.
Get a Safe Healthcare Plan and Keep It That Way
If you are looking for more ways to protect your health, consider investing in a healthcare plan to provide the coverage and benefits you need when you are ill. Now that you have the facts on fraud, you’ll know how to keep it safe. Our agency stands ready to assist you in achieving your long-term health. Call us to schedule a meeting today.
