Medical Profession Role In Insurance Fraud

Posted: Fri Feb 08, 2008 06:46 am Post Subject:

I have heard that medical practitioners often submit themselves to commit frauds, which is utterly disgraceful to their noble profession. They inflate medical bills, file claims for the treatments not done and so forth. They often join hands with the patients, who desire to cheat their insurance companies, by drawing up false and inflated medical bills. I guess maximum of the insurance scams happen in the medical fields. And its quite reflected in the insurance premium rates. What do you say?

Posted: Fri Feb 08, 2008 06:58 am Post Subject:

Hey! aren't we missing out the chiropractors? I think people have lots to complain against them.

Greed being the driving force of our society is encouraging people to commit fraudulent activities more and mores. And what a shame!! its corrupting the health sector as well.

Posted: Fri Feb 08, 2008 07:36 am Post Subject:

Insurance Maze, you have initiated a great topic. I'm sure many will drop-in to this thread. The recent studies have revealed that almost 4-10% of the claims filed with the insurance companies are fraudulent and causes the health insurers to lose around $30 billion every year in US alone. The curbing measures adopted by the regulatory authorities, so far have succeeded is causing the ripples on the lake. The majority of the these activities are still remaining unreported. Hope discussions will spread some awareness among the mass.

Thanks,
Carol

Posted: Fri Feb 08, 2008 11:13 am Post Subject:

I don't know how you could do this insurance maze, but I hope you can figure out a way. Can you come up with a list of ways that the consumer can recognize an insurance scam and report it to thier insurance company. Like what are the most common practices that would be obvious to the untrained eye? Let me give you an example, I have 8 chiropractic visits allowed on my policy a year, never use them all, in fact in 4 years, I visited 3 times when my back was to the point that I could barely walk. The reason I quit going was after the 2nd visit, the chiropractor started talking about other health issues that I did not feel were in his area of expertise, like nutrition and etc. That office wanted to get that full 8 allowed visits out of me. I refused to invest the time. I am not saying that this particular chiropractor is committing fraud, but to continue after the problem is fixed is not going to happen with me. Do you see where I am going with this? What is common practice that may be there for the untrained eye to see?

Posted: Fri Feb 08, 2008 06:51 pm Post Subject:

The thing is with doctors, even though they make a lot of money, it costs an absolute fortune to become a doctor. Not to mention having to fork out for equipment, insurance, medicine, licenses and several textbooks and all.

They need huge amounts of money to get and keep their jobs, so I'm not surprised that some get corrupted. The problem would lessen if they didn't throw all the bills at the doctors.

Posted: Sat Feb 09, 2008 06:11 am Post Subject:

I recently had 3 stitches put in my leg. The Dr spent all of 15 mins tops (and thats stretching it)with me.Cost?? Over 800 dollars!!! Now tell me again why doctors inflate their bills?? I have no health insurnace either ,think they take that into consideration when making out my bill?? I don't think so.Hard to feel sympathy for Dr's when you are looking at a bill for over 800.00 for 15 mins!!!

Posted: Tue Feb 12, 2008 10:57 pm Post Subject:

The recent studies have revealed that almost 4-10% of the claims filed with the insurance companies are fraudulent and causes the health insurers to lose around $30 billion every year in US alone.

Posted: Wed Feb 13, 2008 11:32 am Post Subject:

VERY GOOD POINTS MAZE! My husband has always had what I consider the best mind set with docs (which I can rarely ever get him to go to) and it's simply, ''They are my employee they work for me!" and he's right! If you have that mind set it actually changes how you handle things with the doc...rather than the ''ah...okie dokie'' that most of us do...I changed my way of dealing with them years ago...and has worked out fine for me...for instance, I just recently had a bad breast cancer scare, had one about fifteen years ago as well...this one was looking bad...well I knew from experience, it would go like this, mammogram....oh that's not good, let's do a sonagram...oh that's not good...let's do an mri....now maybe it's ok or we know something, now let's do a biopsy...so when i went to the doc and he said, 'oh crap....(insert my last name which is what he always calls me)......I'm very very concerned about this, let's get a mammogram', i said, 'you know let's just jump straight to where I KNOW this is gonna end up with an mri..he said, 'that's fine if your ins carrier will agree.' so i got them on my cell phone right then and there in his office, they said, 'yep if the doc says it's medically necessary' and had the mri, then biopsy (i'm ok by the way)....thereby cutting out two needless tests....I could give way too many examples, but you get my point...

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as to being a part of or knowing about any fraud....when I was a very young wife/mother...all of about 20...i took a part time (three days a week) job working for a chiropractor in the front office, one girl (me) office, I had zero experience with anything other than working in a shoe store and a battery factory....anyway, it became apparent that there was bad bad fraud going on...what he would do (with me doing the paper work) on many of his 'regular' patients was file claims with their companies showing all of these treatments, that had occured (in the past) then getting paid and then the people would treat, and run down the tab....then when the money was about to run out he'd do it again....after I figured out what was happening I was outta there! (think I worked there all of five months) Eventually years and years later this doc got into a lot of trouble..'duh'...man he was an arrogant a** lot's of other stuff happened too, but anyway that was my experience first hand with a theiving doc...think he actually had to serve some time....

Posted: Wed Feb 13, 2008 01:19 pm Post Subject:

hummingbird
Senior member

Posted: Sat Feb 09, 2008 6:11 am Post subject:

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I recently had 3 stitches put in my leg. The Dr spent all of 15 mins tops (and thats stretching it)with me.Cost?? Over 800 dollars!!! Now tell me again why doctors inflate their bills?? I have no health insurnace either ,think they take that into consideration when making out my bill?? I don't think so.Hard to feel sympathy for Dr's when you are looking at a bill for over 800.00 for 15 mins!!!

Posted: Wed Feb 13, 2008 02:16 pm Post Subject:

Have you ever seen the commercial on TV:

"Get a FREE Hovaround, If Medicare doesn't pay, it's FREE!".

Well, according to the FBI, this seems to be a popular scheme directed toward our senior citizens and Medicare.

Here's how it works:

The doctor must sign a statement that the equipment is "medically necessary" before Medicare will pay for it. So the "Hovaround" salesman either "fakes" the document or "bribes" a corrupt doctor to sign the statement and - bingo - Medicare just bought a Hovaround that the person really didn't need in the first place.