Question

I have to create a essay of Health insurance fraud, types, fines and examples. don't know how

I meant write

Answer 1

Health insurance fraud occurs when insurer or insurance service providers produce false or misleading information with an intention to gain unfair benifits from policy.

Such frauds leads to serious loss to insurance service providers

Fraudulent activities are always criminal although the nature and extent of crime may vary from place to place over a year

There are different types of health insurance frauds

opportunity fraud

Any information which is inaccurate and misleading can lead to opportunity fraud

External fraud

Are committed by the other than policy providers like policy holders, beneficiaries

Internal fraud

Are committed by policy providers like agents and executives

Deliberate fraud

The mistake is deliberately committed to take benifits of insurance

Fraud by policy holders

After knowing the policies of insurance the policy holders tries to take reap benefits from providers

The examples of false policy holders are claim fraud, application fraud and eligibility fraud

Fines of insurance fraud:

In California, if the person commits health insurance fraud of less than $950, the person will be punished with 6 months jail and $1000 fine up on conviction.

If the fraudulent claims more than $950 is punishable with 1 year jail and and $10000 fine

If the fraud amount is higher than this then the person need to pay double of fraud amount and will be imprisoned for 5 years

If it's a health care fraud then the licence of the person can get cancelled

Examples of fraud

1. joan was the only son so he allowed his cousin to use his health insurance card
2. The nurse who got addicted to sedatives used patients card for prescription and purchasing drugs, posing as a family member of that patient
3. The person in the reception who got addicted to painkillers used patients insurance card for paying medicines
4. Dr. Catherine is a surgeon with a low income have performed surgery which was not at all necessary and claimed insurance
5. Dr.Bob, who is a surgeon saw the patients medical records which were falsified that the person have underwent surgery which was never performed

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