Posted: Thu Aug 30, 2007 9:27 am Post subject: Are healthcare frauds a possibility ??
I have heard about some healthcare organizations teaming up with doctors towards cheating the health insurance companies....is it possible ? Can people associated with such noble professions get involved in such activities ?
Hilda Jones _________________ Register Now to have your Insurance queries solved.
Posted: Thu Aug 30, 2007 10:09 am Post subject: True!
My friend, its quite true that healthcare organizations are joining hands with renowned doctors, nurses & in some cases even the policyholders are also becoming a part of these scams!
Believe it or not such scams usually take the shape of pretty realistic schedules involving realistic treatment needs for the patient. This would often arrive at a realistic figure in the form of treatment expenses through magnifying medicine bills, surgery bills & doctor's fees. Even in some cases people are hired to pose as professional escorts to the policy holder!
So you can guess.. regards, Fatman
Posted: Thu Aug 30, 2007 10:37 am Post subject: well-designed scam
Hi All! Its a common phenomenon now-a-days to face the healthcare authorities ask you whether you have health insurance right at the time when you get admitted to a hospital or a nursing home. There begins the story that we all are referring to. They would like to know the nature of your coverage till the amount that you're covered for.
Incase they identify you as someone who doesn't have enough coverage to feed on , they will release you as soon as they can. On the other hand, they would simply ask you to relax and stay out of the communication between you and the health career that you have.
You could rest assured that they would do all that needs them to fetch huge amounts from the pockets of your insurer through exaggerating your medical bills to any desired extent. Then they would sit face-to-face with the insurer and start negotiating with his adjuster. You being the common man would just remain satisfied with the best services from their side.
At least, thats the motto to earn by way of a well-designed scam thats truly hard to prove.
Thanks, ArindamSenIndies
Posted: Thu Aug 30, 2007 10:40 am Post subject: Unfortunate but True!
It's awful but true. I've heard that the doctors at times team up with dishonest policy holders to cheat the insurance firms. They recommend medical tests and medicines that are not often required for the patient. The patient then file claims with his/her insurance company with fake or inflated medical bills.
These incidents not only create distrusts within the society but also pose a threat to the national economy. The consequences of these events are quite understandable.
Posted: Thu Aug 30, 2007 10:46 am Post subject: what happens when the ball lands in your court!
yes, thats quite true ArindamSenIndies!
But We do also come across people who'd often live with the dilemma of turning out to be innocent scapegoats as a result of those negotiations. In case the hospital or healthcare home fails to collect their desired amount from the insurance company, they would often resort to your pocket at the end of the game.
As the ball lands in your court its then upto you to decide how to turn it the other way. It gets very bad for you once you fail to negotiate with the adjuster from your end. Even in some cases as the adjuster agrees to pay a major part of the billing amount, the rest has to be paid from your end. Thats it! Regards, Billie Morrison _________________ Register Now to have your Insurance queries solved.
There have been recent stories in our paper about this one Doctor who had a whole bunch of people in his scam. It seems that he had them "stage" fake auto accidents, and then they came to him for treatments and procedures.
He even went as far as to say to them this is where you tell them it hurts when you move like this, so if they had to go to another Doctor or Disability Doctor, it would sound real.
I,too, knew of a woman that used to be an R.N>, so she knew quite alot about symptoms to tell a Doctor. She went to different Drs., and hospitals claiming heart pains, back pains, and told them her symptoms, and suppossed pain, and got to stay in the hospital for a break, and get all the drugs she wanted. And by the way- paid nothing because she is on a mental disability.That's why she said she likes to go, she can lay in bed, get her drugs, and not pay a penny!! Pretty sad--Karen
People like these Doctors, and this other lady, are why healthcare is so expensive and hard to get for those who really need it!..KAren
Unfortunately, being part of a "noble profession" such as medicine, does not exclude people from being human - and prone to bad judgement.
A human, no matter what profession, is still a human, and you will find some are of noble character to match their noble profession, while others are only out for number 1 - themselves - and the quick buck (or many bucks) they can make, regardless of who they hurt doing it.
