| Insurance fraud is defined as any act committed | | | | the dishonest Physicians and healthcare providers |
| with the intent to fraudulently obtain payment | | | | are known to engage in? The activities include, |
| from an insurer. A big chunk of the total claims | | | | Up-coding/Upgrading (billing for more than actual |
| received by insurers are fraudulent claims that run | | | | service provided) |
| into billions of dollars annually. Health Insurance | | | | Providing and subsequently billing for treatments |
| fraud is today a very serious problem and a great | | | | that are not medically necessary |
| challenge, as it has proved to be very costly to | | | | Scheduling extra visits for patients |
| the US health-care system. | | | | Referring patients to another physician |
| Insurance fraud has occurred in both the public | | | | unnecessarily |
| and private sectors. There is known evidence that | | | | Billing for services to accompanying family |
| our Public healthcare programs such as Medicare | | | | members |
| and Medicaid have been especially conducive to | | | | Ordering unnecessary tests |
| fraudulent activities, as they are often run on a | | | | With newer and better coding systems and |
| fee-for-service structure. One also cannot forget | | | | techniques in place and new policies, vigorous plans |
| the case of the New York based doctors who | | | | are continuously being made to revive the ailing |
| were convicted of defrauding 60 insurance | | | | US health industry. It is hoped that after the |
| companies and a city transit agency of at least | | | | November 2008 Presidential election, the future |
| $15 million through clinic billing scams and were | | | | will bring better reforms with lesser frauds, and |
| later sentenced to be behind bars. | | | | provide efficient and effective health insurance for |
| What are the types of fraudulent activities that | | | | the entire population in the US. |