Health Insurance Fraud

The US health care system is being defrauded of nearly $100 Billion annually.  The single biggest “victim” of this rampant fraud is the Medicare system, which, according to the FBI, is losing nearly $47 Billion per year.  Most of the fraud is accomplished by identity theft, which thieves accomplish by buying info from hospital or insurance administrators,  or by hacking into digital medical records.

With the stolen information, which includes medical insurance information and Social Security numbers, the fraudsters bill Medicare and other insurers for treatment that was never prescribed.  In other cases the information is sold to uninsured people so that they can obtain medical care.

Besides the financial losses to the insurers, the frauds pose a risk to the insured as well.  If someone is piggybacking on your health insurance, information about the other person can get mixed with your own, creating life threatening situations if you have allergies to certain medications or health issues that have to be considered when going into surgery.

As insurance providers push to get all medical information online to save administrative costs, the potential for fraud is only going to increase.  This is an issue that affects us all, because even if our identities have not been stolen the billions lost by the Medicare system are coming out of our pockets in taxes.

There are several things that we all can do to help prevent becoming a victim or to at least detect when we have before much damage is done:

  1. Check your credit report regularly.  Health care fraud can also come in the form of a person using your identity to receive care in an emergency room without being billed for it.  If they used another address and you don’t receive a bill, you may not know that anything has happened until you see collections attempts on your credit report.
  2. Check your insurance benefits statements.  If you see charges that you don’t understand, call your insurance company and have them explain what they are and where the charges came from.  Even though you aren’t covering the costs yourself, fraudulent or incorrect charges could be an indicator that your identity has been stolen.
  3. Avoid carrying your Social Security card.  It is pretty rare that you actually have to present your Social Security card so there is no need to carry it with you.  Keep it in a safe at home.  It will be one less thing to worry about if your purse or wallet is lost or stolen.
  4. Avoid carrying personal checks.  As more and more people pay their bills online and fewer stores and restaurants accept personal checks, there is less need to have checks on your person.  Also, keep the personal information on your checks to a minimum.
Health Insurance Fraud

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