Health Insurance Fraud

Did you know that committing health insurance fraud can land a person in prison? Find out more about how this fraud is committed.

Health Insurance Fraud

What Is Health Insurance Fraud?

Health insurance fraud is when an individual or company provides misleading or false information to an insurance company or government healthcare program in an attempt to receive unauthorized benefits.

How Can an Individual Commit Health Insurance Fraud?

An individual insurer can perpetrate health insurance fraud by:

  • Permitting someone else to use their identity and insurance details to receive health care services.
  • Using insurance benefits to pay for prescriptions that weren’t actually prescribed by their health care professional.

How Can Health Care Providers Commit Health Insurance Fraud?

Here is a list of ways in which health care providers commit health insurance fraud:

  • Billing for procedures or services that were never actually provided. This can be done in several different ways, from identity theft to using actual patient details.
  • Billing for services that are costlier than the actual procedure.
  • Intentionally performing unnecessary procedures to increase reimbursements.
  • Misrepresenting a patient’s diagnosis to legitimize unnecessary surgeries, tests, and other procedures.
  • Billing every stage of a single service as though it was a separate procedure

How to Avoid Health Insurance Fraud?

Health insurance fraud is a serious crime that can lead to millions in penalties and even prison. Here are some tips to avoid health insurance fraud:

  • Understand healthcare regulations and laws
  • Ensure accurate billing
  • Maintain proper and updated documentation
  • Do you know someone engaging in health insurance fraud? File a complaint today.