Healthcare fraud is a crime that involves misrepresenting information, concealing information, or deceiving a person or entity in order to receive benefits, or to make a financial profit. Both individuals and healthcare providers may commit healthcare fraud, in a number of different ways. There are some of the common types of fraud in India:
Billing for services and procedures that were not actually provided to the patient
Providing a service that is not covered under a patient’s insurance policy, then billing for a service that is covered
Falsifying a patient’s diagnosis to justify surgeries or other procedures that are not covered, or are not medically necessary
Duplicate submission of a claim for the same service when it was only performed once
Billing for a different, more costly, service than the one actually rendered, referred to as “upcoding”
Using insurance that belongs to someone else
Staging or faking an accident in order to receive care, medication, or reimbursement for expenses
Failing to remove someone no longer eligible from a policy etc.
Sometimes it is not easy to distinguish whether healthcare fraud has been committed, or an unintentional mistake has been made. For an act to be considered fraud, it must have been committed intentionally, with the intent to defraud. Mistakes happen when an individual, healthcare provider or insurance company accidentally omits information, creates an improper bill, or makes an error in payment. In this case you will need the help of a healthcare fraud investigation agency who will help prove your innocence or reach an administrative settlement or minimize criminal penalties and even identifying the fraud. Otherwise the indicted person may face severe penalties that may include years in prison, steep fines as well as full restitution of wasted Medicaid or Medicare money.
In India this kind of frauds are taking a boom now a days and many insurance companies are facing heavy financial losses due to such fraud claims. There are many fraud investigation agencies which can be very helpful to detect such frauds.
One such company NIDAAN Intelligence Services offers Health Claim Investigation Services to clients across the country.
The Areas that they explore while investigating a claim are:
- Insured’s residence
- Vicinity check
- Neighbor check
- Chemist / hospital / doctor
- Hospital check
- Employer check
- Treating consultant
Get In touch with us at:
Regd. & Corporate Office: 1/2, 1st Floor, B C Dey Complex, D – Road, Near Super Market, Kagal Nagar, Sonari, Jamshedpur, 831011, Jharkhand, India.
Email us: email@example.com