Fraud in the US health care system makes insurance premiums and related health care costs climb higher. This has often been reported in the print media, and on the U.S. House and Senate floors.
Losses incurred on account of health care fraud amount from a staggering $100 to $300 billion.
AdvertisementThe effect of such health insurance hoax is that the taxpayer pays the price for the Medicare and Medicaid bills, apart from the fact that services become dearer.
So, how can the individual American help combat fraud?
The first commandment is to guard one's insurance numbers the way one would protect a credit card or a bank account number. These numbers should not be given to a stranger on the phone, in an email, or on a website.
Secondly, do not carry your health insurance card on your person all the time. Put it in your purse or wallet when you need to use it at a doctor's appointment or in a pharmacy. Or, simply make a copy and black out all the numbers, leaving the last four digits intact.
Thirdly, refuse to entertain people outright if they come to you with free offers of medical equipment or health services, and then ask for your insurance information.
Fourthly, if something doesn't look right on your insurance Explanation of Benefits or your Medicare Summary Notice, assume that there might be fraud involved.
What do you do if you have been defrauded?
1. Contact your insurance company or Medicare if you think anything is amiss after you have reviewed the doctor's statement, the hospital, pharmacy, insurance company, and Medicare statements.
2. It is also appropriate to contact your insurance company or Medicare to resolve incorrect charges or mistakes on your statement. Are there any services that you did not get, but were billed for? Look for multiple billings for the same service. Mistakes are sometimes made while billing and they do not necessarily mean fraud is involved. Point out the mistakes and if they are not corrected, then go ahead and complain.
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