Wednesday, December 14, 2005

Common Health Insurance Frauds

The following is courtesy of:


Medical Equipment Fraud: Equipment manufacturers offer "free" products to individuals. Insurers are then charged for products that were not needed and/or may not have been delivered.

"Rolling Lab" Schemes: Unnecessary and sometimes fake tests are given to individuals at health clubs, retirement homes, or shopping malls and billed to insurance companies or Medicare.

Services Not Performed: Customers or providers bill insurers for services never rendered by changing bills or submitting fake ones.

Medicare Fraud: Medicare fraud can take the form of any of the health insurance frauds described above. Senior citizens are frequent targets of Medicare schemes, especially by medical equipment manufacturers who offer seniors free medical products in exchange for their Medicare numbers. Because a physician has to sign a form certifying that equipment or testing is needed before Medicare pays for it, con artists fake signatures or bribe corrupt doctors to sign the forms. Once a signature is in place, the manufacturers bill Medicare for merchandise or service that was not needed or was not ordered.

Some Tips to Avoid the Health Insurance Fraud:

  • Never sign blank insurance claim forms.

  • Never give blanket authorization to a medical provider to bill for services rendered.

  • Ask your medical providers what they will charge and what you will be expected to pay out-of-pocket.

  • Carefully review your insurer's explanation of the benefits statement. Call your insurer and provider if you have questions.

  • Do not do business with door-to-door or telephone salespeople who tell you that services of medical equipment are free.

  • Give your insurance/Medicare identification only to those who have provided you with medical services.

  • Keep accurate records of all health care appointments.

  • Know if your physician ordered equipment for you.






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Behavior Management Expert and Maximizing Your Potential Mentor™ Etienne A. Gibbs is a life-observing author, engaging talk show host, humorous speaker, and successful trainer who teaches small business owners, managers, and employees how to speak, think, and perform in ways that will help them shine. In the end, they maximize their critical thinking, speaking, and management skills.

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