Health Insurance Fraud
Posted By Administrator
Fraud in the health insurance industry is described as an intentional act of deceiving, concealing or misrepresenting information that results in health care benefits paid to an individual or group. (source)
Members and providers may commit fraud. Members may provide false or incomplete information to become eligible, omit pre existing conditions or file excessive claims for simple procedures. Sometimes doctors and patients collude and come up with false claims that maximize the insurance coverage. Providers may submit claims signed by fake physicians, bill for services not rendered and provide services without a license.
The Health Insurance Portability and Accountability Act of 1996 has established that health care fraud is a federal criminal offense with monetary penalties and punishment of up to 10 years in prison.