There are many different kinds of health insurance fraud.
Health insurance fraud occurs when a person or organization intentionally tries to fool a patient, health care provider or company for financial benefit. Health care fraud can be committed by doctors, insurance companies, chiropractors, health care professionals or hospitals. Health insurance fraud accounts for "between 3 and 10 percent of total health care expenditures," according to the Health Insurance Fraud website.
False Claim Schemes
A false claim scheme is when a doctor or hospital charges a health insurance company more than necessary. A doctor might bill the insurance company for a service he did not provide, or he might bill the insurance company twice for the same service. Some doctors charge more to see patients with insurance than patients without insurance, and then report to the insurance company that the higher fee is their normal rate, according to the Quack Watch website.
Fake Health Insurance Companies
In some cases, scammers will sell individuals health insurance plans from companies that don't actually exist. From 2001 to 2003, four fake insurance companies "left consumers high and dry with approximately $85 million in unpaid medical bills," according to Forbes. Your insurance plan might be fake if you are approached by an insurance agent directly, the insurance costs 25 percent less than normal plans or you have not have not heard of the health insurance company, according to Quack Watch.
Fake Discount Cards
Some scammers sell fake cards that offer a discount of a certain percentage off a doctor's visit. Legitimate insurance companies will offer discounts, but these are usually for small amounts, and the discounts apply only to specific treatments. Before buying a discount, it's also a good idea to check with your doctor and make sure she will accept the discount, according to Forbes.
Inappropriate Testing
Some doctors will order unnecessary tests in order to inflate the cost of treatment. Many tests are useful in making a diagnosis, but ordering a test is inappropriate if it won't influence the doctor's treatment plan. The most common unnecessary tests are ultrasounds, X rays, computerized inclinometry, surface electromyography, nerve conduction studies and spinal videofluoroscopy. This type of fraud is more common among chiropractors, according to Quack Watch.
Medicare Fraud
Those who commit Medicare fraud target senior citizens. Sometimes, medical equipment companies will give senior citizens free merchandise when the senior gives them their Medicare number. Their physician has to sign a form saying the medical equipment is needed before Medicare will pay the bill, but many scammers forge the signature. After the form is signed, the scammers "bill Medicare for merchandise or service that was not needed," according to the FBI.
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