The increasing cases of health insurance fraud are a growing concern for the insurance industry. With a volatile financial situation in the country, insurance companies have to think twice before taking any step. This has however led them to continuously increase monthly premiums making it difficult for the customers to cope with them. A lot of money is spent every year on prosecuting the scam cases and also on the investigation of the same. This additional cost is then passed on to the shoulders of the consumers who have to bear this pointless burden too.
It is estimated that every year the market loses anything from $30 to $100 billion to health insurance fraud. This makes this a very serious cause of concern for everyone. It may seem irrelevant to you but understanding all aspects of health insurance fraud are eventually going to help you only. As a customer being vigilant about it is going to help you fight this evil and save a lot of money which can filter down to you as relaxation in monthly premiums.
For those of us who do not understand what health insurance fraud means here is a brief about it. This is a kind of fraud in which there is deliberate misleading, misrepresenting, or hiding of information in order to get more benefits from the insurance company. What it means is that even without getting a particular treatment done you claim for its insurance money. This could also mean hiding of a condition that will eventually make an ineligible or non policyholder get medical benefits under your policy.
It could be a loved one who may not have insurance but needs medical care. If you are putting this person under your name so that they can use your insurance to cover the charges, you are doing something illegal and this is also clubbed under fraud. This could even lead to imprisonment or fine of a certain kind if you are caught. Even though you may feel the matter is small enough, for your insurance company this can be serious offense.
You will also hear about frauds that target consumers by tricking them to buy fake policies. Consumers are lured in by low premium rates and great benefits. However all this is just a scam and after sometime the consumer is shocked to find when the company or the so called agents no longer exist. Some fraud agents even take this to a high level by posing like a real company and paying for few small physician charges. This is only another way of fooling the customer and extracting bigger amounts from him.
Not just this there are times when even doctors and hospitals participate in these frauds. This is done when a practicing doctor or a hospital charges the insurance company a bigger fee than is actually the case. In cases like these the innocent consumer who has no idea about the fraud also has to participate in the investigations and spend valuable time in it.
Just remember while taking a plan if the deal seems way too good, there may be a hidden catch behind it. Either the company is fraud or you are not getting all that you have been promised. Along with that even you should be totally honest while dealing with insurance companies and be vigilant about what those around you are doing. You can help make insurance better and hassle free. Staying legal is the best way to avoid fines as well as prison.