Health insurance is confusing to most Americans, so it’s no wonder scam artists have a field day bilking millions from unsuspecting victims every year.
For many Americans, affordable healthcare is out of reach, and that is how fraudulent scams work by offering what looks like a great deal for healthcare benefits. Be aware when you are purchasing healthcare insurance, if it seems too good to be true, it probably is. The most common healthcare-related scams to look out for are:
Healthcare Fraud and Scams
1. – Bogus Healthcare Plans – Too Good to Be True
If anyone offers to sell you a great deal on an insurance plan, it’s probably fake. If they offer you insurance at a great deal and don’t require any medical information including a physical, you are the victim of a scam. Most health insurance scams offer watered down plans or non-existent plans. If they don’t show you an actual policy with your benefits laid out clearly, then walk away.
2. – Pressure to Purchase
If they try to pressure you into purchasing quickly, represent themselves as a government agent or say your coverage is “required by law,” you are being scammed. If you receive a fax, email or phone call trying to sell you affordable health insurance, it is most likely a scam.
3. – Misrepresentation
If they say ERISA licenses them, they are lying; health insurance is licensed by the state, not by ERISA which is a federal agency. Any health insurance salesmen that use the term “Obamacare” is not legitimate; they are using terms that people recognize to trick you into buying.
4. – Medical Discount Card
If what they try to sell you is called a medical discount card, you will end up footing the bill for many expenses and never even see a discount. You are buying nothing of value.
5. – Medicare Scams
Many scam artists target older Americans on Medicare to try and trick them into a “better,” and “cheaper” plan and what they get is nothing at all except the loss of their money. In some cases, they scare seniors into believing they will lose their benefits and steal their personal information for identity theft.
Healthcare Providers and Fraudulent Billing
Most healthcare providers are legitimate and strive to help their patients feel better; however, in some cases, providers pad their bills to insurance companies to make extra money. One such example is a medical, psychological care facility that charged insurance companies thousands every time their patients sat in the waiting room watching a movie. They called it “group therapy.” The top scams involving medical billing are:
6 – Billing for Services Not Rendered.
A common scam is when healthcare companies bill for services that were never provided. Insurance companies don’t have the time or money to check up on every bill, so a lot of money is lost this way.
7 – Billing for a Non-Covered Service as a Covered Service.
Often a non-covered expense will be flagged by the insurance company and rejected. So often a fraudulent healthcare provider will code a service as something slightly different that will not cause any red flags and costs more.
8 – Misrepresenting Dates of Service
Sometimes a provider will add a couple of extra service dates which means double the money for services that they never provided. A small change here ends up costing insurance companies thousands.
9 – Incorrect Reporting of Diagnosis
Sometimes just a different diagnosis can increase insurance payments by a lot. Criminal healthcare providers bill for services in line with a more serious diagnosis to get more money. Usually, the insurance company and the patient are completely unaware of this scam.
10 – False or Unnecessary Issuance of Prescription Drugs.
Unfortunately, this is one of the most common and costly scams. Unscrupulous providers write prescriptions for drugs their patients don’t need, most often painkillers, which have a street value of ten times the cost. In some cases, pharmacies are involved in this drug trafficking scheme.
To protect yourself from any of these scams, you can always check on a person’s criminal past here before doing business with them or purchasing any healthcare insurance or related services.