insurance

Steer clear of health insurance scams

Medicare and Medicaid fraud
Bogus Obamacare policies © Keith Bell/Shutterstock.com

The Coalition Against Insurance Fraud says that in 2007 alone, Medicare and Medicaid made an estimated $23.7 billion in improper payments. Medicare accounted for $10.8 billion of that amount. However, as baby boomers get older, the number of seniors joining the program is expected to grow, so those numbers are expected to rapidly expand.

Jeff Young, vice president of fraud control at Verisk Health, says Medicare and Medicaid fraud generally begin at a practitioner's office. The staff members may order tests the patient's condition doesn't warrant, "upcode" or falsify what procedure the patient receives, or bill for nonexistent hours -- "double bill" -- among other illegal practices.

Although these don't necessarily impact the patient out of pocket, it can come back to haunt patients who really do need a medical procedure at some future point, and who could be denied the service based on false evidence. And, of course, there is also the moral issue of ripping off taxpayers.

"Ask questions as a consumer: 'Why do I need this (procedure)?' Get the answers upfront," says Young.

How to spot the scam: While explanations of benefits, or EOBs, can be complicated, always read through them.

What to do: If you spot an error, contact your insurer, either Medicare or Medicaid.

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