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Workplace health care fraud lawyers

June 27, 2020

Healthcare fraud has continued to rise despite the efforts being put by the federal government to curb the vice. According to the latest statistics from the Center for Medicine and Medicaid services, the U.S. expenditure on healthcare has hit more than $3.3 trillion.

However, a good chunk of that money is often lost to healthcare fraud. Independent sources reveal that about 3% of the total healthcare budget is lost to fraudulent claims every year.

How does healthcare fraud happen?

Healthcare fraud happens when an insured healthcare provider or individual provides misleading or false information to an insurance company with the aim of getting paid for unauthorized or unlawful benefits to the insured or another person.

Employers can experience healthcare fraud from employees or insurance companies. Employees can intentionally commit healthcare fraud or they can be victims of fraudsters.

Regardless of the case, insurance fraud can have negative effects on future dealings with insurance companies. That’s why it is important to come up with measures to detect and prevent healthcare fraud.

How healthcare fraud can affect your company and employees

According to legal experts, there are various ways through which healthcare fraud can negatively impact you and your employees.

Some of the common effects include the following:

• Reduced benefits – when the insurance premiums go up, most companies act by reducing employee benefits vision and dental coverage in a bid to save money.
• Increased insurance premiums – an increase in the detection of healthcare fraud and the difficulties in curbing them often leads to insurance companies to increase premiums. This makes it difficult for the company to cover all employees.
• Higher deductibles and copays – Some employers often go for copays and deductibles as the less expensive way of providing their employees with health insurance.
However, this method can place a strain on the finances of employees.

What is considered insurance fraud?

All employees together with their family members who are covered are considered insured. This means that insurance fraud can come from any member of the public.

Although there are various kinds of healthcare fraud, the commonly known ones include the following:

• Use of a health insurance cover to pay for prescriptions not issued by a doctor
• Allowing another person to use your insurance card or identity to acquire health services
• Not removing the name of a person who no longer qualifies for insurance in your cover
• Adding someone who is not qualified to your insurance cover by giving misleading information
• Claiming that you were injured in stage-managed accidents to receive free treatment
• Filing for injury claims based on accidents that didn’t happen
• Exaggerating claims
• Visiting different doctors for the purposes of getting multiple prescriptions

Healthcare fraud detection and prevention

No one would want to imagine that they are recruiting people who would at some point try to or defraud them. However, what you need to know is that some healthcare fraud cases happen without the knowledge of the victims.

Some of the cases happen as a result of identity theft where other people pause as your employees and commit healthcare fraud.

The best thing to do is to educate all employees on healthcare fraud and its consequences. Tell them about the reduced benefits and the increase in insurance premiums that will make it hard to insure them.

You should tell your employees what constitutes healthcare fraud. For example, they should be taught how to review policy statements to ensure that everything is fine.

They should also know how to report anything they suspect to be healthcare fraud to insurance companies and relevant authorities.

In general, workplace healthcare fraud is still a big problem in the United States. It is important to put measures that will help to detect and prevent insurance fraud early enough.



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