Medical Profession Role In Insurance Fraud

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PostPosted: Thu Feb 07, 2008 11:07 pm   Post subject: Medical Profession Role In Insurance Fraud  

People would probably be surprised to know that the majority of insurance fraud concerns the medical profession in some manner.



Does anyone have any experience with any fraud case involving a doctor, hospital, nursing home, hospice facility, medicare, or medicaid?



Come to think about it, that would be a good blog topic.



http://blogging.ampminsure.org



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PostPosted: Fri Feb 08, 2008 6:46 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?


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PostPosted: Fri Feb 08, 2008 6:58 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.


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PostPosted: Fri Feb 08, 2008 7:36 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

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PostPosted: 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?

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PostPosted: Fri Feb 08, 2008 6:51 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.



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PostPosted: Sat Feb 09, 2008 6:11 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!!!

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PostPosted: Tue Feb 12, 2008 10:57 pm   Post subject:   

Quote:
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.




Have you ever really asked your doctor any questions while he/she was in the room?



Most people -

Doctor - "Well, Ms Jones, you need a CT scan."

Ms. Jones - "OK".

Doctor - "Ms. Jones, I think we need to admit you to the hospital for two or three days just for observation'.

Ms. Jones - "OK".



Don't you really want to know why you really need these expensive tests?

Don't you really want to know why you need to be in the hospital?


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PostPosted: 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...



------------------------------------

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....



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PostPosted: Wed Feb 13, 2008 1:19 pm   Post subject:   

Quote:
hummingbird

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Posted: Sat Feb 09, 2008 6:11 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!!!





Wow...... I agree, that is a lot of $$$'s for so little.



But then..... I've paid my auto insurer an average of about $700.oo a year for the last 25 years (total $17,500.oo) and never Filed a Claim..!



At least your Doctor actually Physically did something for you.



Could you imagine sending money directly to your doctor and then never even making an appointment for an office call??



Wouldn't that feel like a major Rip-Off?



FK

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PostPosted: Wed Feb 13, 2008 2:16 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.



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PostPosted: Wed Feb 13, 2008 5:34 pm   Post subject:   

Quote:
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.







Yes, I've seen that TV ad. Its been around for a long time. Long enough that if what you're implying were true, they would have been busted by now.



Its been awhile since I've actually listen to that Ad so my memory may be a little off, but anyway, let me explain my "read between the lines" understanding of that Ad.



They promise "If you qualify" they will do the paperwork and get one for you. Adding that if "they" fail, they will provide you one FREE!



Do you see the catch? Its in Quotes.



If you don't qualify for Medicare... Not their problem, they didn't fail, No free chair.



If you send them false or inaccurate information... Not their problem, they didn't fail, No free chair.



Is it Fraud or Clever marketing of a Service?



Hopefully only those that need this service apply and are given a more mobile and enjoyable life.



And that the Crooks are caught by the Medicare Fraud detection systems. And are at least denied or better yet prosecuted.



---------------------------------



I was curious about the FBI comment... so... I went to their page. The only and closest info I could find along the line of your comment was:



Medicare Fraud:



Quote:
Medicare fraud can take the form of any of the health insurance frauds described above. Senior citizens are frequent targets of Medicare schemes, especially by medical equipment manufacturers who offer seniors free medical products in exchange for their Medicare numbers. Because a physician has to sign a form certifying that equipment or testing is needed before Medicare pays for it, con artists fake signatures or bribe corrupt doctors to sign the forms. Once a signature is in place, the manufacturers bill Medicare for merchandise or service that was not needed or was not ordered.






I don't see "Hovaround's" name anywhere in the FBI info. Which makes your "So the "Hovaround" salesman either "fakes" the document or "bribes" a corrupt doctor to sign the statement and..." seem very, very, wrong.



I think (don't know) the FBI is referring to Real con men, like internet phishing schemes etc., not likely valid Prime time TV ads.



I could be wrong.. but maybe not.



FK

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PostPosted: Wed Feb 13, 2008 6:47 pm   Post subject:   

I think you are probly right Guest. Does not say Hoverround. To the guest above, If you have paid over 17 thousand in premiums and never filed a claim as I have never either.Bet if we did our rates would go up ,You think?,

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PostPosted: Wed Feb 13, 2008 8:08 pm   Post subject:   

Quote:
hummingbird : Senior member



Posted: Wed Feb 13, 2008 6:47 pm Post subject: Medical Profession Role In Insurance Fraud



----------------------------------------------------



I think you are probly right Guest. Does not say Hoverround. To the guest above, If you have paid over 17 thousand in premiums and never filed a claim as I have never either.Bet if we did our rates would go up ,You think?,





So far I (FK) am the only one that has Post as Guest in this thread. (twice)



I Registered but the system won't let me use my registered name. I think I mis-typed my password and don't know what letter(s) are wrong. Still waiting for a response from "AMPM insure" to fix it.



In the mean time you can spot my "Guest" Posts by the signature at the end. FK



About your insurance co. rate increase comment. I would hope not for a minor accident, but...



...I got stopped for a technical violation on of the Right turn on Red law. It was a one red light town, 1 AM, no traffic. the light changed to red as I entered the intersection. So rather than slam on the brakes and backup, I continued to drift through the turn at about 8 MPH.



To make a boring story shorter. The end result was a dui. first & only. (haven't drank since - nearly two years now. and I don't miss it)



My insurer of about 40 (that's Forty) years dropped me like a "Solid lead spear into a bottomless Quick-sand Pit".



Never a late payment, never a problem.



The funny part is.... they did me a favor. I've learned that price is all that counts and I'm saving big time with a different company.



FK

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PostPosted: Thu Feb 14, 2008 12:03 am   Post subject:   

Quote:
I don't see "Hovaround's" name anywhere in the FBI info. Which makes your "So the "Hovaround" salesman either "fakes" the document or "bribes" a corrupt doctor to sign the statement and..." seem very, very, wrong.




My entire point was that there are medical equipment salesmen and health professions involved in Medicare fraud. I used Hoveround (Hovaround) just as an example, it could have been a wheelchair, a cane, a hospital bed or any other type of medical equipment.



But I did find an add in Yahoo specifically about the item in question:



Quote:
Since breaking with tradition to sell its products direct to consumers, the company has occupied what some would call an enviable, and others objectionable, position in the HME industry. There is no question that its national television advertising remains controversial. Many beneficiaries say that Hoveround has bettered their lives; many manufacturers and providers view the company as an arch-foe.




Do you guys have a financial interest in Hovaround? Laughing


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