Exagerrated health claims

Submitted by Anonymous (not verified) on Fri, 02/17/2006 - 05:39

I had stooped to pick up this phenomenal piece from a news daily and wanted to know a way out of this scenario !

A 54 years old San Mateo county collections employee was found blameworthy of faking injury to her own physicians. She has also been perceived of amplifying the state of her health and continues to echo her sufferings from reflex sympathetic dystrophy syndrome (RSD).

RSD is a neurological disorder often identified with weakening pain. In October 1998, she had claimed to have paralyzed her right hand, and also stressed on being unable to lift objects, drive her car or even shake hands with people. The employee had been taken into custody after the days proceedings at the court.

Posted: 18 Feb 2006 05:55 Post Subject: Not worth paying !

Hi !

This is April signing back to share some information gathered from a recent websearch referring to a fascinating chain of events from the United States Attorneys Office for the Southern District of Florida.

The guilty plea of a defendant was announced in connection to a conspiracy to commit health care fraud involving an aids clinic. According to the news network, the conspirator and his allies had offered money to patients in order to get them involved with the services offered by the clinic. The clinic had claimed to have specialized in the treatment of patients infected with AIDS or HIV. The conspirators produced some fabricated bills for which worth $714,000 were paid off as claims. It has been a highly successful mission for a recent healthcare fraud program aimed at tracking down individuals indulging in healthcare scams shattering the health insurance programs sponsored by the government.

Posted: 20 Feb 2006 10:17 Post Subject: Bureau triumphs

Hey Sandwin,
My latest online surfing revealed an interesting report depicting the release of a document in connection to the procedures which inflicted a statewide fall in terms of auto insurance premium rates.
It reflects back some of the successful undertakings of the federal bureau in 2005, which includes several fraud related arrests involving federal, state and local officials. It also highlighted more than 40 arrests based on an investigation throwing light upon some of the notable fake accidents in the vicinity of the New York City and the Buffalo area.
It also discloses facts as to how an act of humiliation caused to the Westchester County's no-fault auto insurance system by the illegal operations of a medical facility came to an end. The report has been thoroughly backed by the Frauds Bureau's 2006 legislative recommendations and some key statistical output. Now if you'd seriously make a note of these facts & consider them while taking fresh decisions, then it might come to good use.
Regards, Beatrice NY

Posted: 05 Sep 2007 10:41 Post Subject:

Unfortunately, healthcare fraud is rampant, wide-spread, and ever-changing. There are always people out there with new ideas on how to defraud our insurance carriers, and with every new idea, every new fraud case, the premiums for everyone else go up. (I know that's only part of the reason that premiums go up, but my personal feeling is that it's a BIG part of it.)

There are actual medical reasons for some of the fraud - but they are not on the part of the patient! Some parents or caregivers actually have a mental disorder called Munchausen By Proxy Syndrome, which makes them feel that they have to cause injury or illness to their child or loved one - severe enough that it requires medical attention or hospitalization - in order to gain attention for themselves. Kind of a "poor me, look at my poor child/loved one, give me attention" type of thing. That doesn't make the insurance fraud involved any less criminal, but it does shed some light on some cases. The patient is actually ill or injured, but the illness or injury has been caused by someone who intentionally caused the injury/illness in order to benefit from the attention.

Posted: 06 Sep 2007 04:45 Post Subject:

My mom was recently in the hospital again and her roomate was something else!

It seems she lives in assisted living, and every month or two gets "tired" of being there. Her Doctor sends her to the hospital because she has undefined pain. I was thinking-poor thing- until she told me her Doctor lets her stay the maximum days the insurance pays- she gets her meals served and watches tv in bed- then goes back!!

I asked the nurse why they let her do this, and the nurse said, it's all about the money- but I didn't tell you that!!

No wonder alot of us cannot afford healthcare! My premium for my husband and I alone is $900.00 a month!!

Posted: 06 Sep 2007 04:50 Post Subject:

Oh my gosh, Karen! I hate to see someone abuse the system that way. There's so much of it going on nowadays.

Posted: 18 Dec 2007 11:03 Post Subject:

Some injuries on people who make these claims can also be self-inflicted, or made to look much worse than they actually are.

For example; one nasty mishap I had last year left me with the Queen Mother of all bruises on my left arm. Someone could show something like that to a doctor and try to take advantage of the system for some extra pennies, even though it was just a really nasty bruise. I'm sure any respectable doctor would see right through it though.

I've heard a few stories of people exaggerating injuries after minor car accidents, yes, whiplash is painful, and some injuries might not take a toll until weeks, maybe months later. Sorry, but I doubt putting a wee dent in a bumper is going to leave a healthy person in a body cast.

Like I said before; when people commit insurance fraud, it's the honest people that end up paying the bill.

Not to generalize or anything, but some exaggerated claims might just be people with a case of Munchausen Syndrome. Which is where people fake, or even inflict pain or illness on themselves to get attention, usually in the form of medical help. I'm not a psychologist so don't quote me on it.

Posted: 20 Dec 2007 07:49 Post Subject:

Taking a look at the compensations claims that people collect on would be an interesting report, it amazes me how long people are allowed to stay on workers compensation, some people are on it for years and years and years. It is unbelievable, you would think that the insurance agency would get tired of paying out the claims, year after year.

Posted: 27 Dec 2007 12:19 Post Subject:

These kind of companies deal with a colossal number of claims every year, it can be hard to pick out a single person unless they actively look for it. Not to mention that they have to prove that they no longer deserve it in some cases.

It goes unnoticed most of the time.

Posted: 28 Dec 2007 11:27 Post Subject:

I just don't know how they afford to pay out for so many years, My husband friend was on compensation for over 20 years before they finally settled it out and now he is on social security disability, yet he helps his girlfriend daily at her resturaunt, just amazes me too. I think he could actually go back to work, he is volunteering there at the resturaunt, now that everything is settled. I would be surprised if social security would take a look at his employability and put him in some case of job coaching or other programs that are offered through the office of vocational rehabilitation. It is obvious the time he puts in at the resturaunt that he is able to retain employment, but it is hard to tell what he is telling his doctors.

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