Insurance fraud is defined as any act committed with the intent to fraudulently obtain payment from an insurer. A big chunk of the total claims received by insurers are fraudulent claims that run into billions of dollars annually. Health Insurance fraud is today a very serious problem and a great challenge, as it has proved to be very costly to the US health-care system.

 

Insurance fraud has been in both the public and private sectors. There is known evidence that our Public healthcare programs such as Medicare and Medicaid have been especially conducive to fraudulent activities, as they are often run on a fee-for-service structure. There was the case of the New York based doctors who were convicted of defrauding 60 insurance companies and a city transit agency of at least $15 million through clinic billing scams and were later sentenced to be behind bars.

What are the types of fraudulent activities that the dishonest Physicians and healthcare providers known to engage in? The activities include,

With new and better coding systems and techniques in place, and newer policies and vigorous plans being made to revive the ailing US health industry, it is hoped that the future will definitely bring better reforms with lesser frauds, and provide efficient and effective health insurance for the entire population in the US.  

The author of this article is Ricci Mathew of OSI (Outsource Strategies International ), a US based company that offers services in Medical Coding, Medical Billing and Medical Transcription for clients across the US.