SALT LAKE CITY, Utah (ABC 4 News) - Health insurance fraud is becoming one of the nation's biggest businesses, costing Americans billions of dollars every year.
According to the Insurance Information Institute, the annual loss of health care fraud will reach a staggering three hundred billion by the year 2013.
Jeff Young is a clinical analyst for Salt Lake based Healthcare Insight - a market leader in fraud prevention. He reviews fraudulent insurance claims submitted by doctors and hospitals.
Young sees deception in the form of major dollar amounts every day. "You've got the providers that are so savvy with this. They lie under the radar. Their whole goal is that you will not see that claim and you won't look at the whole picture," says Young.
Health insurance fraud is a low risk crime, according to Healthcare Insight President Dr. Barry Johnson. Scams range from false claims to fraud rings who have access to patient ID's.
"They sell them to somebody who sells them to an illegitimate provider, who submits hundreds of bogus bills with stolen identities," says Johnson.
Even though some scammers are caught, the consumer ends up paying the price, one way or another. "The consumer pays through higher premiums, higher co-pays, and even deductibles," says Johnson.
There are ways the consumer can take control and avoid falling prey to insurance.
fraud.
1. Report your insurance ID card if it's lost or stolen
2. Thoroughly review your Explanation of Benefits
3. Stay informed about your medical care
4. Keep detailed records of all medical statements and bills
5. Beware of "free" offers
6. Report waived fees
7. Get recommendations when it comes to selecting a doctor
8. Always get a 2nd opinion
9. Purchase insurance plans and products with care
Dr. Johnson also advises getting a list of all of your services paid for by insurance at the end of each year.
Overall, insurance companies and providers are ramping up measures to fight fraud, but ultimately, it's up to consumers to be vigilant. "If we were better consumers like we are with anything else we buy, then there would be much better control over this," says Johnson.
For more information on reporting fraud, visit www.stophealthcarefraud.com.
