Healthcare Frauds Need Attention, Demand Healthcare Events


In recent years, healthcare frauds have taken a significant toll on the healthcare industry, becoming a matter of discussion and concern at various healthcare conferences and events.

With time these medical frauds are becoming challenging as the insurance companies are losing thousands of dollars to these frauds, which are expected to grow at a rate of 6.2% per annum. Losing so much on medical fraud is a rising issue that needs to be addressed before it takes away all the insurance money.

Healthcare fraud includes everything from unadministered treatments to fake diagnoses to avail higher insurance amounts. This is done to get more insurance value than what is spent. Let’s explore a few common methods adopted by people, as highlighted at the healthcare events like the Health 2.0 Conference, to avail more returns from the insurance companies.

Most Discussed Types Of Healthcare Fraud At Healthcare Events

  • Upcoding


This is the most common type of healthcare fraud which involves billing for the services that were never provided or were provided cheaply, but the bills were inflated by an individual for reimbursement. An inflated code for the individual’s actual diagnosis is used and shows that it matches a severe condition and expensive medical procedures. As discussed at post-COVID healthcare conferences of 2022, fraud insurances like these cost a lot to the insurance companies and thus affect the healthcare economy.

  • Kickback Schemes


Kickbacks are the most flourishing schemes in the healthcare industry. Although these are illegal by the government, for any doctor to receive any valuable thing from another doctor, healthcare professionals, organizations, or anyone else in return for any references, prescriptions, medications, or to make any decisions based on unethical exchanges.

  • Improper Medical Charges


Many times, individuals don’t sign up for the added medicare facilities suggested for their diagnosis but try to get that money from the government in the form of insurance. This is again an illegal yet mostly practiced fraud activity in the healthcare sector.

  • Unnecessary Medical Services


As the instances of unnecessary medical procedures for claiming insurance are constantly rising, one needs to remember that the reimbursement takes place only for procedures or tests relevant to the individual’s conditions. If a doctor suggests tests, processes, or other medical services irrelevant to one’s condition, the referral is invalid and is a violation of the healthcare terms and conditions.

  • Unbundling


Unbundling is basically the fragmentation of the bill. The healthcare professionals bill every step of treatment as a separate treatment or procedure. Unbundling involves-

  • Fragmentation of one service into many different services
  • Reporting multiple separate codes even though a single code is present for a medical service
  • Separating a surgical approach from a single surgery

This is done basically to get more insurance claims from the insurance companies.

  • Medical Identity Thefts


In medical identity theft, a person’s name or other personal information is used without the person’s consent or knowledge to obtain medical services. Also, the stolen identity is then used for fake insurance claims that can hugely impact the theft of individuals and their insurance.

As discussed at many healthcare conferences and events, medical fraud is an expensive activity that drains a lot of money from insurance companies. After brainstorming on such medical and healthcare frauds, many policymakers and healthcare professionals put forth a few invaluable suggestions. Let’s explore the possible ways to prevent medical fraud.

Quick Tips For Insurance Holders

  • Take Care Of Your Documents

One of the most crucial guidelines to prevent oneself from medical fraud is to take care of one’s medical documents like social security numbers, medical insurance cards, and so on, and as with the increase in medical identity thefts, keeping one’s documents safe and away from fraudster’s reach is always suggested.

  • Educate Yourself About Medical Insurance Policies


Often, individuals are only aware of the possible benefits of playing with the medical insurance policies to avail of more reimbursements. But, it’s equally essential for people to know about the penalties and fines imposed by the government in case their insurance file is suspected and considered illegal by government rules.

  • Billing Procedures & Process


The whole plan and billing process should be explained to an individual either by their insurer or the insurance company. Once the clients are aware of the government’s process, steps, and inspection policies, they hesitate to involve themselves in malpractices.

  • Consult An Attorney


In case of any doubts or complaints against a particular healthcare organization, it’s better to consult an attorney first, as directly contacting the healthcare would encourage them to delete their files or evidence that can put them into trouble. Confirm your incident with an attorney, and then you can legally proceed with it.

Final Thoughts


It’s time to raise questions against medical frauds/ fraudsters, and this is seriously impacting the healthcare insurance sector. If it continues to prevail, it will affect the genuine patients of their insurance. Also, a check is required on the healthcare organizations, patient case studies and treatment, and the documentation of the insured individual. One can witness many such insurance fraud issues at the 2022’s post-COVID healthcare conferences like the Health 2.0 Conference, along with solutions that can help one avoid getting into such medical and healthcare frauds.


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