The looming threat of fake health insurance claims in the us


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Fraudulent medical billing and insurance fraud are major threats in the US healthcare sector. Comprehensive medical record review can help expose false medical claims.

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The looming threat of fake health insurance claims in the us

  1. 1. 1-800-670-2809 The Looming Threat of Fake Health Insurance Claims in the US Fraudulent medical billing and insurance fraud are major threats in the US healthcare sector. Comprehensive medical record review can help expose false medical claims. A recent report in Yahoo News threw light on the actual and alarming existence of health insurance fraud in the United States. The estimate is that the state of Florida alone incurs a huge amount of more than a billion dollars a year as costs of personal injury fraud. This loss is passed down to the consumer who is faced with higher insurance premiums. The article traces the actions of agents and police officers on a mission to arrest around 20 people who they suspect are part of a personal injury insurance fraud ring. The modus operandi of the fraudsters is staging accidents where obviously no one gets hurt. Physicians, medical clinic owners, therapists and alleged accident victims are all said to work together to fake car accidents and secure money from insurers. As mentioned in this report, the passengers 1-800-670-2809
  2. 2. 1-800-670-2809 who are not in fact injured go to the personal injury clinic that has been set up by the fraudsters to receive their share of the money while the healthcare providers submit claims for up to $ 10000 per person for treatments that were never provided. The really distressing thing is that for a perfectly orchestrated car collision, a car with 4 passengers could easily bring in $ 40,000. Government Disclosure about Healthcare Fraud The FBI website highlights healthcare fraud as a major threat to the well-being of American citizens and the overall economy of the nation. Such fraudulent activities cost the country an estimated $80 billion a year. What is rather unnerving is that there are medical professionals who are willing to risk patient safety by getting involved in such schemes. In May this year, Attorney General Eric Holder and HHS secretary Kathleen Sebelius announced that the Medicare Fraud Strike Force had carried out operations in 8 US cities and brought in charges against 89 individuals that included physicians, nurses and other licensed medical professionals for participating in Medicare fraud schemes that involved around $223 million in false billings. False claims were submitted to Medicare for medically unnecessary treatments and for treatments that were never provided. It was seen that Medicare beneficiaries, patient recruiters and other joint conspirators in the schemes were paid cash kickbacks in return for providing beneficiary information to healthcare providers. These providers would then submit false claims to Medicare for services that they never performed or that were medically unnecessary. 1-800-670-2809
  3. 3. 1-800-670-2809 In the various coordinated takedowns by the Medicare Fraud Strike Force, at least 600 individuals have been charged for partaking in schemes involving almost $ 2 billion in fraudulent medical billing. Comprehensive Medical Record Review Can Expose Fraudulent Medical Claims It is true that healthcare fraud exists in enormous proportions, and people who have sustained injury often approach attorneys in relation to their personal injury claims. It is important that the details of the injury substantiate the accident. This can be ascertained only through a thorough medical record review. A comprehensive review of the medical documents can throw light on all aspects of a personal injury case and identify misleading information, ambiguous information, missing information and other anomalies in the medical records. A medical record review company with its professional medical review staff can locate any tampering within the medical records including fraud and billing errors. When it comes to settling medical claims, detailed medical record evaluation has an important role to play. Professional medical review services help to properly organize the medical records provide the chronology and summary and opinion of the records for law firms, establish the authenticity of the medical claims, and thereby ensure that patients who have been really injured are represented well, while fraudulent claims are exposed. 1-800-670-2809