How Do Authorities Combat Medical Insurance Fraud?

Medical insurance fraud is combated by authorities in a variety of ways. The price of medical insurance fraud is paid by all insured persons and affects the type of care that you receive. This cost translates into higher premiums, co-payments and a reduction in some benefits provided to insured individuals.

What Constitutes Medical Insurance Fraud


Fraud such as false statements, fraudulent claims, providing services that are not medically necessary or providing false identification in order to use someone else’s insurance hurts everyone. Instances of insurance fraud such as these examples are investigated by an insurance company’s claim investigation unit and when irregularities are noted, reported to a state’s commissioner or department of insurance, state police and even the federal bureau of investigation for follow-up and prosecution.

Maintaining a Vigilance over Medical Insurance Fraud

It is a federal crime to engage in fraudulent insurance claims. This prohibition is also found in many state’s law. Authorities have the tool to test, verify, audit and determine if an incident of fraud has taken place. Authorities also provide information to insurance companies and insured individuals concerning the penalties and sanctions associated with medical insurance fraud as a way to discourage individuals from engaging in such behavior.



Misselling



Misselling is an unethical practice that some financial professionals use in order to try to sell securities to investors. This practice typically involves leaving out important facts that would help the individual make an educated decision about the product. Many times, the salesperson will also try to make the individual believe that this particular product is urgently needed and should be purchased immediately. This is a common tactic in the life insurance industry. Many life insurance salespeople will try to sell large life insurance policies to individuals who do not necessarily need them in their particular situations.

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