Health care scams cost
Americans billions of dollars each year. Taxpayer-funded programs
such as Medicare, Medicaid and others are among the biggest victims.
This makes health-care fraud one of America's largest taxpayer rip-offs.
Organized crime rings hatch many
schemes. Hospital chains, individual employees and even patients
also can be involved -- as victims or perpetrators.
price you pay
Special consumer alert:
bogus health plans, 10 warning
medical cards - what you should know
Most medical providers are honest
and ethical. But here are just some of the health care scams you
should know about...
Phantom treatments. Dishonest
medical providers will bill health insurers for expensive treatments,
tests or equipment you never received and for illnesses or
injuries you don't even have.
Double billing. Unethical
providers may double or triple bill health insurers for the same
treatments, hoping the insurer won't discover the overruns in the
big stack of bills.
Shoddy care. You might
receive shoddy or substandard treatment for real and urgent medical
problems. One eye doctor shined pen lights into patients' eyes and
said he'd performed cataract surgery. Surgeons have used defective
pacemakers and catheters during heart surgeries, which have killed
patients or required more surgeries to correct the problems.
Unneeded care. You might
receive dangerous and even life-threatening treatment you don't
need. One surgeon performed heart surgery on patients who didn't
Bogus insurers. Insurance
agents or brokers sell you low-cost health coverage from fake insurance
companies. Then they take your premiums and disappear. You're left
without vital health coverage, and don't even know it until you
make a claim.
Identity theft. Cheaters
steal your medical ID number, then use it to bill health programs
tens of thousands of dollars for phantom treatment. Crooks steal
your health info from dumpsters behind medical clinics, break into
doctor offices and steal files, and hack into computer databases
containing your records.
Rolling labs. Mobile diagnostic
labs give needless or fake tests or physical exams to consumers,
then bill health insurers for expensive procedures.
Runners. A person hired
by a medical provider to drum up business trolls through neighborhoods,
often low-income areas, enticing people to come to a clinic for
tests. These runners will even roundup children for unneeded tests
The price you pay
Coverage drained. Your
coverage limits might be drained by worthless and unnecessary treatments.
Financial disaster. Inflated
or phantom medical bills can increase your co-payment, beyond your
ability to pay. This could force you into collections and damage
your credit rating. And if you bought health insurance that ends
up completely fake, you could face financial disaster if you must
pay large medical bills with your life savings because your policy's
False medical record.
record contains false information about illnesses, diseases, injuries
or other problems you never had. Your information is available to
insurers, so you could be denied health coverage or pay higher premiums
because of a trumped-up medical record.
Premiums rise. Your health
premiums rise because insurers pass the cost of fraud onto policyholders.
High health premiums discourage employers from offering this needed
Personal distress. You
receive bogus or needless treatments that are painful, distressing,
can threaten your health and even kill you.
Taxpayer rip-off. Billions
of your tax dollars pay for fraudulent claims against Medicare,
Medicaid and other taxpayer-funded health programs every year. These
are your tax dollars being stolen.
- Keep detailed records of treatments
you receive. Include all dates, locations, who provided the treatments,
what services you received, and what medicine, supplies or equipment
- Carefully review the billing
and summary statements you receive after treatment. Are the treatment
dates, doctor name(s), facility locations and medical services
the same as you remember? Know what medical equipment and supplies
your provider ordered, as well.
- Never sign blank insurance
- Ask your medical providers
what price they charge, and what you'll pay out-of-pocket.
- Avoid door-to-door or telephone
salespeople who offer you free medical services or equipment.
- Never give strangers your
policy number, insurance ID number, Medicare claim number or other
info, especially if they offer you cash or free gifts, treatments
- Know what your medical benefits
are what's covered and what isn't.
- Back off if someone says they
can bill your health program to pay for an uncovered treatment
or equipment. You're being pulled into an illegal scheme. You
could lose your health coverage, be arrested, fined, thrown into
jail, and live with a conviction record that disrupts your life
for years to come.
- Never pay your health premiums
in cash, and be wary if the health insurer asks you to pay a full
year's premium upfront.
- Be careful if medical providers
say they're connected with the federal government, Medicare, Medicaid
or other health programs.
- Watch out if the insurer offers
you health coverage for "just pennies a day," or sells coverage
at a price far lower than others.
- Check with your state insurance
department to make sure the health insurance company is licensed
to do business in your state.
- See if the health insurer
has a history of consumer complaints, bankruptcy, fraud convictions
or other problems. Your state insurance department and consumer
protection agency, and Better Business Bureau are good places
- Question your health provider
and ask for clarification if you see problems or inconsistencies
on your bills.
Who to contact
If you think you've discovered
a health-care scam, contact:
- The insurer that paid the
claim (the name, address and phone are on the explanation of benefits
you receive in the mail).
If you think the scam victimizes
Medicare, Medicaid or another public health program:
- Phone: the U.S. Department
of Health and Human Services toll-free: 1-800-HHS-TIPS (1-800-447-8477)
Office of Inspector General
Department of Health and Human Services
330 Independence Ave., SW
Washington, DC 20201
- Contact your state fraud bureau.
Make sure you include this information
when you contact the authorities:
- provider's name and identifying
- item or service you're questioning
- date(s) you supposedly received
the item or service
- amount approved and paid
- date of the explanation of
- name and Medicare number of
the person who supposedly received the item or service
- why you believe Medicare shouldn't
- other information that might
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