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Health-care fraud is a problem that occurs throughout the world. It hurts consumers, who end up paying higher premiums, as well as damaging the businesses that are also getting defrauded. In the United States, for example, it’s estimated that health-care fraud costs businesses and consumers at least $80 billion a year.
This type of illegal activity can manifest in several ways. One example is billing for services not rendered. For example, corrupt medical practitioners may bill for expensive procedures that were never performed, bill for a single procedure or medical item more than once or in the worst case scenario actually perform procedures when they are clearly not necessary. These corrupt practitioners are often tempted with “kickbacks” (also known as bribes) by those who are to benefit from the fraud.
“Unbundling” is another example of a way that health care providers may defraud the consumer. In this type of fraud, services that are cheaper when bundled into a package are charged for separately to increase their overall price.
How to Protect YourselfIt’s a good idea to record all the receipts and statements you receive from your health insurance provider, and to check them for any mistakes or irregularities. As a rule, you should never give your insurance details or ID number to strangers claiming to represent the service provider, except via the service provider’s official communication channel. Also look out for fake e-mails. Always check the sender’s address closely for inconsistencies with other e-mails from the health insurance provider, as fraudsters will often attempt to closely replicate your insurance provider’s email address.
Keeping records of any and all doctor’s visits, tests and procedures will make it easier to spot any items and services you never in fact received, or that have been billed for more than once. Always ask your insurance provider to explain if you don’t understand your bill. If they are unwilling or unable to do so then you would be better of reviewing health insurance providers and moving over to a different provider.
Fraudulent Health Claims for ProductsAnother common form of fraud is making untrue claims about the curative or otherwise miraculous health properties of medicines. This type of health scam has existed since the days of the travelling snake-oil salesman. There’s still plenty of truth to the old saying that if something sounds too good to be true, it most likely is.
Today crooks have new channels for peddling their wares, like television infomercials, radio, magazines and now the Internet too. A recent study indicated that the majority of victims of this type of fraud are 65 years of age or older. Many fake claims relate to treatments for conditions commonly associated with old age, like memory loss, arthritis and impotence.
You should suspect that you’re being duped if you encounter claims that a treatment is made from a secret, ancient or otherwise mystical formula. Also be wary of claims that medicines available online or over the counter can cure diseases that modern medical science doesn’t fully understand, such as cancer and arthritis.
Ultimately all forms of health care fraud end up hurting consumers, so be on the look-out and do what you can to help ensure more transparent health care.
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