Health insurance fraud refers to an intentional act of deceiving the healthcare provider and availing the health care benefits. Usually health insurance fraud is done for getting the payment from the health insurance company. Several studies show that more than thirty billion dollars are lost every year in U.S because of health insurance fraud. So many health insurance companies have felt the need of investigating fraud for the benefits of their members.
Health insurance fraud may not necessarily mean the fraudulent practices of members. It can be committed by insurance providers as well. Members may avail benefits for disqualified dependents or other members. They may alter the enrollment forms and may underreport other coverage.
Providers may bill the services that are not offered at all or they may bill expensive treatments, diagnosis etc that are outside the scope of practice. There are independent medical examinations for demystifying insurance claims. In United States, there is an increase in the healthcare fraud. It is a considered as criminal offense with punishment of ten years.
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