Insurance 101 – Chapter 16 Volume 95 – FRAUD CHECKLIST

FRAUD CHECKLIST

Response to fraud checklist.

The following video was adapted from my book, “Insurance Claims A Comprehensive Guide” Published by the National Underwriter Company and is available at the Zalma Insurance Claims Library

Legal Disclaimer

The author and publisher disclaim any liability, loss, or risk incurred as a consequence, directly or indirectly, of the use and application of any of the contents of this blog. The information provided is not a substitute for the advice of a competent insurance, legal, or other professional. The Information provided at this site should not be relied on as legal advice. Legal advice cannot be given without full consideration of all relevant information relating to an individual situation.

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Insurance 101 – Chapter 16 Volume 94 – SUMMARY-3

 SUMMARY-3

Malcolm Sparrow of Harvard’s Kennedy School of Management cited the dead as a glaring example of how much more needs to be done “to properly excise the cancer of fraud” from healthcare. The healthcare industry does “a terrible job of crime control,” Sparrow told a Senate panel, with almost no procedures to routinely verify that medical claims presented were true, or that services provided were medically necessary.

The following video was adapted from my book, “Insurance Claims A Comprehensive Guide” Published by the National Underwriter Company and is available at the Zalma Insurance Claims Library

Legal Disclaimer

The author and publisher disclaim any liability, loss, or risk incurred as a consequence, directly or indirectly, of the use and application of any of the contents of this blog. The information provided is not a substitute for the advice of a competent insurance, legal, or other professional. The Information provided at this site should not be relied on as legal advice. Legal advice cannot be given without full consideration of all relevant information relating to an individual situation.

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Insurance 101 – Chapter 16 Volume 93 – SUMMARY-2

SUMMARY-2

Reporting on the inadequacy of governmental oversight of Medicare and Medicaid, a U.S. Senate committee reported last year that Medicare had paid as much as $92 million from 2000 to 2007 for medical services or equipment ordered or prescribed by doctors who were dead at the time. Many had died more than five years before the date when they supposedly ordered or authorized the service.

The following video was adapted from my book, “Insurance Claims A Comprehensive Guide” Published by the National Underwriter Company and is available at the Zalma Insurance Claims Library

Legal Disclaimer

The author and publisher disclaim any liability, loss, or risk incurred as a consequence, directly or indirectly, of the use and application of any of the contents of this blog. The information provided is not a substitute for the advice of a competent insurance, legal, or other professional. The Information provided at this site should not be relied on as legal advice. Legal advice cannot be given without full consideration of all relevant information relating to an individual situation.

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Insurance 101 – Chapter 16 Volume 92 – SUMMARY

SUMMARY

What has been the result of these battles against fraud? Has the number of prosecutions for insurance fraud increased? Not to any appreciable degree. The prosecution of insurance fraud is still rare. State statutes compelling insurers to form fraud investigation units usually have no penalties if the insurer fails to establish such a unit (compared with California regulations that impose a $55,000 fine for failure to establish a SIU or loss of the certificate of authority to do business in the state). This situation seems unlikely to change until states put in place statutes similar to California’s IFPA that facilitate prosecution of fraud.

The following video was adapted from my book, “Insurance Claims A Comprehensive Guide” Published by the National Underwriter Company and is available at the Zalma Insurance Claims Library

Legal Disclaimer

The author and publisher disclaim any liability, loss, or risk incurred as a consequence, directly or indirectly, of the use and application of any of the contents of this blog. The information provided is not a substitute for the advice of a competent insurance, legal, or other professional. The Information provided at this site should not be relied on as legal advice. Legal advice cannot be given without full consideration of all relevant information relating to an individual situation.

 

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