Healthcare Fraud
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Most dentists are ethical professionals. A small but disturbing number are dishonest. They exploit their position of authority to bilk trusting patients with useless and often painful treatment, and shady billing practices.
The scams:
Unneeded treatment - Perform useless surgery on healthy patients to hike their insurance billings. The dentists remove healthy teeth, do root canals that aren’t needed, and drill for cavities that don’t exist.
Inflated billings - Dentists do minor procedures such as routine tooth cleanings, but bill your insurance plan for costlier treatments.
Phantom treatment - Dentists bill insurers for treatments they never perform. They send the insurer forged bills.
Unqualified employees - Some dentists have unqualified staff perform treatments — yet bill as if the dentist performed the treatment.
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Fake and deceptive health plans promise full coverage, but deliver worthless or no benefits. Leaving large medical bills paid from your pocket.
The scams:
Phony benefits - The plan promises full-benefits at low prices. Including pre-existing conditions, specialists and other essential benefits. Watch for cold callers, fake websites, email pitches and TV ads.
ACA-required - Falsely claiming coverage is mandated by the Affordable Care Act, Medicare, Obamacare or even “Trumpcare.”
Pays little - You receive a limited-benefit or discount plan paying few or no expenses.
Fake website - Websites urge you to buy coverage online. They want your credit card. The website appears to be from a legitimate insurer, or an official Affordable Care Act signup portal.
Bogus association - You have to join an “association” or “union” to buy coverage. Typically these groups are fake.
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Your health plan covered your surgery, or maybe childbirth. At least you thought. Then large bills pour in afterward. They’re uninsured, forcing you to pay from your pocket. Maybe for an extra surgeon or anesthesiologist.
Surprise medical bills are increasingly common. Your medical facility used personnel who are out of your health plan’s network. Nor were you told in advance, or given a chance to shop around.
The Scams:
Surprise billings can be legal though unwelcome, unfair and financially draining.
Out-of-network charges can be fraudulent. Maybe for a physician when a nurse should’ve been used. Or needless extra tests or medical equipment were ordered.
Dishonest doctors illegally bribe colleagues to be included and billed in your surgery or other medical procedure. These are illegal kickbacks.
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Thieves steal your medical identity. They line their pockets with false health care claims. Malware, hacks, phishing, and robocall spoofs increase your danger. The scams
Illegal and bogus treatment - Thieves bill your health plan for fake or inflated treatment. Organized rings sell your information on the Dark Web.
Addictive drugs - Medical providers steal painkillers or other drugs using your name — they feed their addictions or sell for profit.
Stealing treatment - Uninsured persons receive free medical treatment courtesy of your health policy. Often trusted friends or relatives stole your information.
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Dental Scams:
Verify you need the treatment - A dentist may urge treatment that seems unneeded — such as eight cavity drillings. Get a second opinion to confirm you need the work.
Check out dentists - Call your state insurance department and state dental board. Was the dentist disciplined for wrongdoing? Currently licensed?
Review your explanation of benefits - Make sure your insurance plan is billed only for treatments and supplies you received.
Suspect a swindle? - Contact your insurer and state insurance department. Contact Medicare or Medicaid if you have these benefits.
Stay with your kids - Some dentists perform unneeded surgery on kids — especially those covered by Medicaid. Ask to stay in the treatment room to ensure no excessive procedures are done.
Fake Health Plans: Sickening:
Licensed? - Contact your state insurance department to make sure the plan and agent are licensed.
Go slow - Avoid signing up if you’re pressured to buy quickly— or the price seems too low.
Read - Review the policy before buying. Have a qualified expert review. Does the policy deliver what the sales pitch promises?
Verify any “association” or “union” - Does it have a website? Is the site vague about its activities and mostly hypes health coverage?
Notify your insurance department - Contact your state fraud bureau if you think you’re dealing with a fake health plan.
Surprise Medical Billings:
If possible, ask your health insurer, doctor and hospital what bills you’ll have to pay. Also ask for the projected cost. Get a signed and written agreement.
Shop for the best deal that’s covered by your health policy.
Appeal surprise bills to your insurer. Request that the insurer pay.
Contact the medical facility and your health insurer to review bills. Billed for treatments you didn’t receive? Unrequested out-of-network charges?
Some states protect you from certain surprise bills. This is especially true of medical emergencies. Check with your state insurance department.
Consider contacting a state-level consumer advocate for help.
Contact your state fraud bureau if you suspect fraud.
Medical Identity:
Be careful Beware - Providers never text or email sensitive medical info. Use the provider’s secure portal or call
Phishing - Bogus emails and calls claim to be a health insurer or government agency. Don’t share your health policy, credit card or SSN Never open unknown links.
Avoid public wi-fi - Don’t log into your health accounts on public wi-fi. Thieves troll open wi-fi sites.
Keep Healthy
Verify - Review all explanation of health benefits statements to confirm treatments are valid.
Defend your credit - Check your credit reports regularly for fraud.
Medical records - If you suspect ID theft, notify your medical provider to correct medical record errors.
Report - Report any identity scam to your health insurer, state department of insurance and police. You’re on record your information was stolen.
Most important of all, don’t commit insurance fraud and if you see it happening, report it.
And finally, pass our information along to everyone you know.