Health Insurer On Alert For Fraud
By Julie M. McKinnon, The Blade, Toledo, Ohio | |
McClatchy-Tribune Information Services |
A combination of fine-tuning methods to detect fraud and an increase in schemes is causing an increase in fraud cases, Medical Mutual officials say.
More patients, for example, falsify applications to get health coverage after losing benefits or jobs.
Doctors, hospitals, and other health-care providers are up against dwindling
"I think we get better at it [detection] every year," said
He added: "Providers are trying to get all the money they can right now."
The
Medical Mutual also works with the
Two Medical Mutual cases investigated last year resulted in federal indictments. In one, the former owner of a medical infusion and medical supply company in
As a result, consumers face higher premiums and other expenses, Medical Mutual officials said.
But patients can help detect fraud by questioning doctors about whether suspect tests or other services are necessary, as well as by examining their statements carefully, officials said.
"We try to make it easy for people to tell us about fraud," said
"If they didn't have something done, we want to know about it."
Said
Just a small percentage of doctors and hospitals statewide commit fraud, Medical Mutual officials emphasized.
The insurance company has had a financial investigations unit since 1983.
About 80 percent of fraud cases involve doctors, hospitals, chiropractors, podiatrists, dentists, and other health-care providers, said
Consumers and insurance brokers account for the remainder of cases, said
Medical identity theft is becoming a problem, with patient information being sold to outfits that then bill false claims, said
Organized crime also is playing a role in health-care fraud, Medical Mutual officials said.
They had a case in which a group of doctors and chiropractors with locations in several states, including the
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