Why Many Claim Fraud Is one of the Biggest Threats to Affordable Healthcare

One of the most expensive bills for any household will always be health insurance. For years, insurance companies have been giving a number of reasons why the price of plans keep going up and up. Whether it’s higher running costs, an increase in chronic diseases linked to obesity, or maybe even linked to the COVID-19 pandemic, there’s a whole list that some insurers regularly choose from. Now insurers are claiming that healthcare fraud is one of the biggest problems facing the industry. 

What is healthcare fraud?

To explain it in the most basic of terms, healthcare fraud is the act of unlawfully taking money from an insurer. This can happen in a number of ways. Whether its doctors prescribing unnecessary treatments, billing for more expensive treatments than necessary or even billing for treatments that were never given, there are a number of ways in which the system can be abused. Some patients can also find themselves having insurance claims submitted in their name without even visiting the doctor. The act of “ghost patients” sees doctors submitting claims for treatments that never took place for patients they’ve never met.

How is it policed?

The main problem with combatting healthcare fraud is that it can be difficult for insurers to decipher a legitimate claim from a fake one. Previously companies would have had to go through millions of transactions, trying to spot suspicious patterns from providers. Either that or they would heavily rely on whistle-blowers to tip them off that suspicious activity is occurring. Now insurers are increasingly using technology to try and catch out criminals. Most recently, an artificial intelligence programme has been developed to help spot suspicious activity without the need for human interaction. 

Now technology is flagging up more cases, many more doctors will be investigated. It’s highly likely that we’ll also see an increase in innocent doctors having to justify their actions to legal professionals. Luckily there are Healthcare Fraud Group defense lawyer Orlando FL who are standing up for the rights of these doctors. They help guide medical professionals through the process of clearing their name which can often be time consuming, stressful and affect both their work and personal lives. Whilst it’s important criminals are caught, it’s even more important that ethical doctors can quickly get back to helping improve others health.

How big is the problem?

Healthcare insurance companies can make their owners millions or even billions of pounds every month. You might think that because of this, many companies wouldn’t want the hassle and possible negative press coverage of taking a doctor to court and having to prove without reasonable doubt they are guilty. The fact is that a huge amount of money is recovered each year through this process. A recent report estimated that $260 billion is lost to fraudulent activity every year in the health industry across the globe. Whilst a sizeable percentage of money is wrongfully spent, the government and law enforcements will continue to come down hard on fraudulent activity. 

All opinions expressed on USDR are those of the author and not necessarily those of US Daily Review.