What Hospitals Can Do to Prevent Health Insurance Fraud

Health insurance scams are on the rise, and the government and health care organizations are renewing their focus on stopping them.

While most health insurance providers are honest, there are some that sell fake policies and medical discount cards to their customers.

Advances in technology, better availability of information and greater awareness have helped the government, medical facilities, physicians and consumers combat fraud more effectively these days, but there is still a lot more to be done.

Here is a look at some common health insurance scams and measures that hospitals and other medical outlets can take to prevent them.

Fake Health Insurance Policies

Health insurance scammers often target individuals, small businesses and associations, and they try to trick them into buying their fake policies by promising low premiums and guaranteed approval without medical exams.

Many of them operate through sophisticated syndicates that have strong marketing and money-laundering capabilities, and they may even be linked to organized crime.

Usually, people who have purchased fake health insurance do not know that their policies are fake until they need to file claims.

Fake Obamacare Policies

While the implementation of Obamacare promises better health coverage for Americans, it also opened a new way for scammers to prey on health insurance buyers.

According to an article entitled "Health Insurance Scams Using Health Care Bill," health insurance scam artists began targeting seniors, low-income people and others who need health insurance desperately as soon as the new health care bill was passed.

While some of them offer fake Obamacare policies, others try to commit identity theft by telling their targets that they need their social security and bank account numbers to help them get a national health card.

Phony Medical Discount Cards

Phony medical discount cards are usually presented as a way to get discounts for various medical services or an alternative to health insurance.

These cards are often sold to low-income individuals and families. They come with lists of phony health care providers, fake discounts and high hidden fees, but they do not provide actual benefits.

Some of the sellers of phony medical discount cards also try to get people to disclose their personal information in an attempt to steal their identities.

Reducing Health Insurance Scams

There are a number of things that hospitals can do to prevent health insurance scams.

First of all, they can try to raise awareness of these scams and provide advice on how to avoid them. This can be done by sharing information about health insurance scams on their websites or newsletters, or during consultations.

Additionally, hospitals can use fraud detection software to combat health insurance fraud. 

The Fraud and Abuse Management System developed by IBM is an example of software that can help them reduce financial losses that result from health insurance scams.

It detects fraud by analyzing claims data and identifying insurance providers that deviate from the norms of their peer groups. Some hospitals have set up special investigation units to prevent health insurance fraud.

Health insurance fraud can have serious consequences for patients, medical organizations, insurance providers and the government.

It is a costly crime that should not be overlooked.

About the author: John McMalcolm is a freelance writer who writes on a wide range of subjects, from social media marketing to cloud computing.