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Healthcare Insurance Fraud Could Be Cut 15% With Undercover Patients

By Lisa Olsen Posted in Health Insurance News

Healthcare insurance fraud could be cut 15% with the use of undercover patients and a little forensic accounting. In what is deemed as yet another excuse by big insurers for the reason insurance is so high, insurance companies blame fraud as reason for continual rate increases.

Why Not Stop Suspected Fraud

Fraud is a crime, period. It does not need to be in the healthcare industry to be seen as unlawful. There are laws in place, federal and state, that deal with the crime of fraud, why not use them to stop the practice. A little proactive work on the part of the insurance company could stop this abuse, put the criminals in jail and keep rates at an affordable price.

If a hospital or doctor is suspected of overcharging or committing fraud, send in undercover patients and review the bills and treatment. A forensic accountant could find overcharges and misuse of insurance billing in a matter of days. Build up a case against the offender and then prosecute. Companies do this everyday to keep their books in order and their internal costs down. Why don’t the insurance companies feel the need to enforce their own procedures instead of overlooking the problem and charging the patients more?

The answer is simple: They don’t have to demand accountability. With the government in the insurance companies back pocket, insures do not need to enforce any type of accountability. They simply raise their rates, throw their hands up in frustration and the government looks the other way. In fact, the government is so concerned about these high campaign contributors, that they continually make legislation that allows the insurers to act irresponsible. The insured are the ones who pay for the obvious carelessness of the insurance company.

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