group health insurance plans, health insurance for children, health insurance for self employed, health insurance for small businesses, low cost health insurance plans, medical coverage, mortgage fraud, small business health insurance plans, travel medical insuranceHealth insurance fraud is described as an planned act of misleading, concealing, or misrepresenting information that results in health care benefits being paid to health insurance policy holder.
Both a policyholder and a health insurance provider can commit fraud. Policyholder fraud consists of disallowed members and/or dependents, alterations on enrolment forms, concealing pre-existing conditions, failure to report other coverage, prescription drug fraud, and failure to disclose claims that were a result of a work related injury. Provider fraud consists of claims submitted by bogus physicians, billing for services not rendered, billing for higher level of services, diagnosis or treatments that are outside the scope of practice, alterations on claims submissions, and providing services while under suspension or when license have been revoked. Independent medical examinations are used to debunk false insurance claims and allow the insurance company or claimant to seek a non-partial medical view for injury related cases.
Details here: http://en.wikipedia.org/wiki/False_insurance_claims
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