Checklist to Detect Fraudulent Insurance Medical Billing

Checklist to Detect Fraudulent Insurance Medical Billing

Medical billing fraud is rampant in America. Now there is a new form of this type of fraud. Instead of consumers taking advantage of insurance companies, insurance companies are now taking advantage of small businesses. Fraudulent insurance companies are putting a new spin on medical billing fraud.

The National Association of Insurance Commissioners is currently providing a checklist to distinguish fraudulent insurance plans from legitimate ones. Sometimes small businesses don’t have the resources or the money to investigate possible insurance companies. This checklist provides a quick way to filter possible insurance scams. Like any other issue in medical billing you should always use your common sense. In addition to the checklist items, there are other things you can do to protect yourself. Make sure you do your homework and read the fine print before signing on the dotted line . You can save yourself a lot of medical billing fraud by reading what you sign.

A main theme that runs through the medical billing fraud checklist is: if something seems too good to be true, it probably is. For example, anyone who promises rates below the average market price might be shady. Medical billing reimbursement is the same for everyone, so that means premiums should all be similar. Also, an extremely large network of providers and employee benefits might also be a red flag. If someone promises you the world, they might be lying.

Another medical billing red flag is the pressure to act now. Any company that will not give you enough time to investigate their organization or review their plan, may be shady. Important advice to follow, is to always fully examine each insurance company and the plan offered.

When dealing with the sales agent for the medical reimbursements company, if you don’t trust him/her, don’t sign. Sales agents should never be vague. They should completely and fully answer all of your questions without any hazy responses. The way they treat you is the way they will treat your employees and providers looking for medical billing reimbursement. If they act like they have something to hide, they probably do.

Medical billing fraud is an important issue to be aware of. Protecting your small business and protecting your practice from medical billing fraud should be one of your top priorities.

View all Articles by: Melissa Clark, CCS-P