what is Medical Fraud? & a short history

Medical fraud is an intentional deception or misrepresentation made by a person with the knowledge. that the deception could result in some unauthorized benefit to himself or some other.

Health insurance is designed to provide access to necessary treatments, preventive services and emergency care to individuals and families in need, and, apparently, now it’s also used to hand out paydays to scammers.

In February of this year, Change Healthcare fell victim to a cyber-attack that impacted thousands of health care providers, insurers and policyholders nationwide. Reports from this incident suggest that around 50% of all US medical claims could be at risk! To put that into perspective, if you’re in the waiting room with nine other people, there’s a good chance that five of you could fall victim to medical identity theft within the year. The aftermath of this fraud is staggering, affecting countless individuals and their access to health care. Once your medical information is exposed online, these identity thieves can use it to file false claims, buy expensive prescriptions and more, and it will all be conveniently billed to your account.

The worst part is how some people are finding out they were affected. Some are facing tax or mortgage fraud, but others are going to the doctor to find out if they need a procedure, but instead of getting a surgery date, they’re handed a rejection letter from their insurance provider, claiming the company won’t cover it because they’ve exhausted their benefits from multiple other procedures this year. But the thing is, THEY didn’t have any other procedures this year. Someone stole their medical ID and used it for their own procedures.

And it’s not just individuals you have to worry about. Manipulative organizations can use your medical information for fake billing schemes. What happens is that they submit false claims for medical services you never requested, received or knew anything about, then they collect their payday, and stick you with the bill. In July, 193 defendants, including 76 doctors, nurse practitioners and other licensed medical professionals, were charged for their alleged participation in several different health care fraud schemes that resulted in 2.75 billion in false billings to federal programs. Medical fraud happens!

See next weeks article for 10 signs on that you are a victim of medical fraud.