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Battling Health Insurance Claims Fraud

Insurance companies and providers of health care benefits lose hundreds of millions of dollars yearly due to fraudulent claims for health benefits. Some of these are bogus claims that originate from insured persons, while others are payments for insured services that are not needed but are wrongly prescribed by providers who stand to make illegal profits.

The U.S.-based National Health Care Anti-Fraud Association estimates health care fraud costs the nation no less than $68 billion annually — about three percent of the nation’s $2.26 trillion in health care spending. Others say that number may be substantially higher.

The bottom line is fraud costs everyone through higher premiums or through tax dollars spent on public health benefits. Benefits fraud is a serious crime and is treated that way by law enforcement agencies around the world.

This white paper will outline common schemes and case studies to help your organization prevent or uncover fraud ahead of it being paid out.