Winter is upon us, and with it comes the dreaded flu season. In turn, this means more trips to the doctor’s office and the potential for high medical bills – a monetary incentive that fraudsters have not overlooked. According to the FBI, healthcare fraud costs the United States an estimated $80 billion a year, with schemes that risk patient health and raise medical bills across the board.
While this statistic may sound exaggerated, recent reports provide a case in point. Just this week, four people were convicted in the nation’s largest medical fraud case to-date, with doctors accused of recruiting thousands of patients for unnecessary surgeries in a $154 million bid to scam insurance companies. Medical and insurance fraud is a very real threat, and it plays a significant role in the rising cost of patient care.
Below, I’ve outlined a few of the most common forms of medical fraud, and I’ve highlighted 4 important steps you can take to protect both your wallet and your health.
Billing for services that did not take place
Don’t remember getting your wisdom teeth pulled last month? Submitting claims for fabricated procedures is one common way that providers take advantage of unsuspecting consumers (and insurance companies). If an insurance claim shows up for a procedure or visit that you do not remember, trust your instincts and contact your medical provider directly to investigate.
Falsifying diagnoses to provide unnecessary treatment
Even if you are perfectly healthy, fraudsters can fabricate diagnoses to con patients into paying for treatment. While shocking cases of unnecessary surgeries do exist, most common are easily overlooked diagnostic testing schemes, in which patients are conned into unnecessary testing or blood work. If you think that a service offered is an unnecessary add-on, it may be a good idea to seek out a second opinion from a trusted medical provider before agreeing to medical care. This is especially true for high-cost and high-risk procedures such as surgery.
Overbilling or “Upcoding”
Upcoding refers to charging for a more complex or expensive service than was actually provided. Similar to submitting a false diagnosis, providers can inflate a patient’s needs on paper in order to collect payment for expensive testing or treatment.
While the above methods of medical fraud are a few of the most common, there are many others not mentioned here that could compromise your insurance benefits or risk physical harm. To help protect yourself and your healthcare information, there are a few best practices I hope many of you will implement as flu season 2012 kicks off.
1. Keep track of healthcare records
One of the best ways to prevent fraud is to stay aware. Maintaining a paper trail of records, invoices, insurance benefits, and policy statements will make it much easier for you to verify all charges to your accounts, identify fraudulent claims, and reconcile any overcharges or upcoding.
2. Guard your medical identity
In many cases, unauthorized charges can slip under the radar if fraudsters have direct access to your insurance information. As a best practice, never give out Medicare or insurance information to any unauthorized or suspicious source. This includes “deals” on medical services made over the Internet or phone, door-to-door salespeople, or even close friends and relatives. Remember, your medical identity is extremely valuable, and scammers will go after anything they deem worthy.
3. Know your policy and benefits
Another simple way to stay ahead of the game is by getting to know your insurance policy. Read the packets sent by your insurance company, and understand what you will and will not be charged for. This will help you identify false claims and call out suspicious activity.
4. Don’t fall for “free”
You know the rule: If it sounds too good to be true, it probably is. If an offer for free or discounted medical services seems too generous, there may be strings attached. Always double-check the reputation of medical practitioners online and with your insurance company to guard yourself from crooked providers.
Here at McAfee, we’re all about the relentless pursuit of safe. Healthcare scams are one of the most insidious forms of fraud, but like many threats we see, they are crimes of opportunity. By keeping track of your records and steering clear of suspicious providers, you can help make healthcare safer and more affordable for everyone.