Keep Legal! Avoiding Insurance Fraudulence
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Everyone knows that medical insurance industry is regularly raising monthly premiums, and several feel this is unjust for your requirements as the consumer. Then again, the health insurance industry has had to fight increasing health insurance policies fraud. The amount of investment property on investigating and prosecuting fraud is then given to to policyholders. Many people tend not to understand what health insurance policies fraud entails, though. With reports estimating health insurance fraud is a $30 million to over $100 billion industry a year, the topic should definitely not be taken lightly. Every health insurance policyholder should understand what health insurance fraud is and it has the consequences. By doing consequently, you are more competent to recognize and fight fraud.
Health insurance fraud is commonly defined as intentionally deceiving, misrepresenting, or concealing information to receive benefits through the insurance company. Essentially which means that you assert that you covered certain medical procedures or expenses out-of-pocket that you choose to have not actually received, and you are submitting claims to the insurance company to receive reimbursement. Another example of member fraud should be to conceal pre-existing conditions or alter medical documents so non-policyholders or ineligible people receive medical benefits less than your policy. Perhaps your sister does not have insurance and wants medical attention. Having her use the name and policy for the expenses is health insurance fraud. While you may think that this is a small issue in comparison for a sister receiving treatment, it is actually very serious to any health issues insurance company and market, and will result inside fines and possible imprisonment if your are caught.
Not only policyholders commit fraud, although providers (physicians, hospitals, for example.) do as well. Since physicians and hospitals bill the insurance vendor for services they look after you, they are also receiving reimbursement through the insurance company. When vendors commit fraud, they may perhaps be billing the insurance company at higher rates pertaining to services rendered or they might bill for services you never received. In most of these cases, you will probably be asked to cooperate while in the insurance company's investigation.
Another type of health insurance fraud containing developed recently targets the policyholder over the insurance company. Schemes have developed where fake insurance carriers or agents sign unsuspecting shoppers for coverage at interestingly low premium rates. They often act a lot like a regular insurance company for your first few months, venturing into smaller medical claims like physicians visits. But upon having a more serious problem that needs treatment, the insurance company will disappear - and also the money you have happen to be paying in premiums.
The rule with health insurance fraud is much like this of any other scam: if a deal seems too good to get true, just remember : it probably is. Remember in truth in your dealings with health insurance companies and expect the same in the return from these businesses, as well as any health issues care providers. Stay legal to avoid fines and prison in order to continue receiving health insurance.
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