Can someone explain insurance fraud related to filing medical claims? I need to know whats legal/what's not?
Posted on Jul 11, 2008 under Insurance Information |I would like to know what the legal issue is with filing outragious dollar amounts on insurance claims. Do the insurance companies investigate large dollar claims that seem above and beyond? Where do I go for more help?
July 11th, 2008 at 9:54 am
Yes they can… and will. You must proove your damages, and you can spend a long time in prison if caught. Filing a false claim or even "padding" your claim is illegal… It's just like stealing. If you have done this, you may want to get an attorney.
July 11th, 2008 at 9:54 am
truth is legal, lies are not
July 11th, 2008 at 9:54 am
basically any fraud little or big and its up to 250,000 in fines and 10 years i think in jail. We just had a little old lady go to jail for faking perscriptions.
July 11th, 2008 at 9:54 am
Its very serious. Typically, anyone filing a false insurance claim, will be making a false police report to back up the claim (depending on the type of claim). That is a felony, just like an insurance fraud charges. So the act of telling the police, then telling the insurance company, you will be two felonies deep before they even think about writing you a check. Most people think that to be charged with fraud, you have to actually collect money. Not true. Just lying to the company with the intent of getting money will do it.
And once you are caught for even a little padding, you will be reported to the National Insurance Crime Bureau, for all other insurance companies to see. Most people work harder trying to keep the lies straight in their bogus claims, then it would take to make an honest living.
I've seen alot of good people do stupid things to insurance companies because they think its a victimless crime. A cute mother of 3 never does well in prison. Its just not worth it. You will accidently tell someone, and that someone will tell on you when they get bent about how much their insurance premiums are.
July 11th, 2008 at 9:54 am
Insurance companies investigate all claims, even the little ones. The most common form of medical insurance fraud is called "Upcoding." Basically, a doctor will see you for 10 minutes, but charge for 20. From there, it escalates to billing for services not rendered or actually doing services that are medically unncessary.
Not only can it result in fines and jail time, you will be reported the National Insurance Crime Bureau. If you ever try to make another claim, even a legit one, it will be red-flagged and closely investigated and monitored.
If you are aware of Insurance fraud, or suspect it, call your state Insurance Board, or the NICB (both phone#s are available online). They will be able to tell you if something is illegal or not.
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