CLEVELAND, March 5 Armed with some nifty software and asmall, but ambitious staff, John Shoemaker, manager of Medical Mutual ofOhio's Financial Investigation Unit uncovered $4.9 million in fraudulentactivity for the year ending 2007, according to figures just released by theCleveland-based health insurer.
On average, Shoemaker and his staff investigate 120 cases of potentialfraud per year and have produced more than 700 indictments in 20 years. Overthe past five years, Medical Mutual has reclaimed more than $20 million fromfraudulent activity.
The costliest of all crimes, the National Health Care Anti-FraudAssociation (NHCAA) estimates more than $100 million is lost every day tohealth insurance fraud. Shoemaker and the NHCAA said everyone pays for healthinsurance fraud and there are ways consumers can help prevent it:
Protect your health insurance card like your credit card. In the wronghands, a health insurance card is a license to steal. Don't give policynumbers or other identifying information to door-to-door salesmen or telephonesolicitors.
Read your policy and benefits statements. Read your policy, Explanation ofBenefits (EOB) statements and any paperwork you receive from your insurancecompany. Make sure you actually received the treatments for which yourinsurance was charged, and question suspicious expenses.
Beware of "free" offers. Offers of "free" services are often fraud schemesdesigned to bill you and your insurance company illegally for thousands ofdollars of treatments you never received. If it sounds "too good to be true,"it usually is.
Report fraud quickly. Don't put it off. Call your insurance companyimmediately if you suspect you may be a victim of health insurance fraud.
According to the NHCAA, health insurance fraud is responsible for upwardsof five percent of the total cost of all health care in the United Statesannually. "Our mission is to simply try to help hold the line against higherhealth care costs," said Shoemaker.
Shoemaker said the fraud-sniffing software plays a huge part in nabbinghealth insurance fraud artists by flagging irregularities in insurance claimfilings. "This software helps us focus efforts on cases most likely to havefraud," said Shoemaker. "This year, the company has almost five millionreasons to believe our staff and software are working quite well together."
Founded in 1934, Medical Mutual of Ohio is the oldest and largest healthinsurance company based in Ohio. The company serves its customers throughhigh-quality, affordable group and personal health insurance plans, and third-party administrative services to self-insured group customers. Based inCleveland, Medical Mutual also has offices in Columbus, Cincinnati, Toledo,Akron, Dayton and Youngstown. For more information, visit the company's award-winning Web site at MedMutual.com.
SOURCE Medical Mutual of Ohio