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Explaining Health Insurance Fraud   

https://zalma.com/blog

The nation\\u2019s bill for health care fraud is enormous \\uf0be as large as $300  billion or more every year. Fraud takes place at many points in the  health care system, in hospitals, nursing homes, and diagnostic  facilities, by doctors, attorneys, health care providers, durable  equipment providers, and patients. One large area prone to fraud is the Medicare system. This system  processes more than 800 million claims a year with 70 different  contractors handling the claims that come from hundreds of thousands of  doctors, laboratories, and other health practitioners and facilities.    In 2012 Medicare paid out over $817 billion dollars. If only five  percent went to fraud, they took over $40 billion and if ten percent  went to fraud more than $81 billion was paid to fraud perpetrators. I  have heard estimates up to 30 percent of payouts are fraudulent. The  numbers, regardless of the percentage, are excessive.   Surveys show that it is usually the claimant who perpetrates the fraud,  as opposed to health care providers, employers, or attorneys. The most  common fraudulent activity is a false statement or omission of  information, i.e., lying about the severity of an injury or failing to  mention a pre-existing condition then profiting by obtaining a portion  of the amounts billed from the provider.  \\xa9 2021 \\u2013 Barry Zalma  Barry Zalma, Esq., CFE, now limits his practice to service as an  insurance consultant specializing in insurance coverage, insurance  claims handling, insurance bad faith and insurance fraud almost equally  for insurers and policyholders. He also serves as an arbitrator or  mediator for insurance related disputes. He practiced law in California  for more than 44 years as an insurance coverage and claims handling  lawyer and more than 52 years in the insurance business. He is available  at http://www.zalma.com and zalma@zalma.com.  Mr. Zalma is the first recipient of the first annual Claims Magazine/ACE  Legend Award.  Over the last 53 years Barry Zalma has dedicated his life to insurance,  insurance claims and the need to defeat insurance fraud. He has created  the following library of books and other materials to make it possible  for insurers and their claims staff to become insurance claims  professionals.  Go to the podcast Zalma On Insurance at https://anchor.fm/barry-zalma;  Follow Mr. Zalma on Twitter at https://twitter.com/bzalma; Go to Barry Zalma videos at Rumble.com at https://rumble.com/c/c-262921; Go to Barry Zalma on YouTube- https://www.youtube.com/channel/UCysiZklEtxZsSF9DfC0Expg; Go to the Insurance Claims Library \\u2013 https://zalma.com/blog/insurance-claims-library/ Read posts from Barry Zalma at https://parler.com/profile/Zalma/posts; and the last two issues of ZIFL at https://zalma.com/zalmas-insurance-fraud-letter-2/  podcast now available at https://podcasts.apple.com/us/podcast/zalma-on-insurance/id1509583809?uo=4