Buyer Beware: Identifying Health Insurance Fraud

Summary: Scam insurance is not new - criminals have been selling fraudulent policies since health insurance came into being. But with today's skyrocketing health care costs, more consumers are seeking affordable access to quality care, which provides scam artists with fertile hunting grounds.

Scam insurance is not new - criminals have been selling fraudulent policies since health insurance came into being. But with today's skyrocketing health care costs, more consumers are seeking affordable access to quality care, which provides scam artists with fertile hunting grounds. By appealing to consumers' insurance cost concerns, these individuals successfully entice more than 100,000 Americans into purchasing sham health insurance every year. Consumers should always be on the lookout for common insurance scams. Some warning signs of fraudulent plans include: * dramatically low premiums; * guaranteed coverage - regardless of pre-existing conditions; * lack of the word "insurance" anywhere in the materials; * plans that ask for premium payments in cash or for an entire year up-front. It is important to evaluate the agent selling the plan. Agents who claim that they do not need a license to sell insurance or imply that their product is exempt from state regulation should be rejected. Consumers should be wary of any agent claiming to represent a medical provider who solicits customers door-to-door or patrols neighborhoods encouraging residents to visit a mobile clinic for routine checkups or tests. Many organizations, including the National Association of Health Underwriters, are educating their members and consumers about how to recognize insurance scams and protect against them. To keep from being victimized, consumers need to do their research and use a reputable insurance agent or broker who is knowledgeable about scam insurance. Consumers can locate a local NAHU member to help them find the right health insurance plan by going to www.nahu.org and using the "Find an Agent" feature. Suspected insurance scams should be reported as soon as possible. Most states sponsor fraud bureaus that investigate insurance scams, and some even reward whistleblowers if there is a conviction. The financial effects of these schemes are felt throughout the entire health care industry. Victims of insurance fraud will have to repay uncovered medical bills and depending on how long they go without legitimate insurance coverage, may also lose health care insurance access permanently. Health care facilities and medical professionals, meanwhile, may never be paid for the treatments they administer. The only way to stop the spread of insurance scams is to learn how to detect fraud and work to prevent such criminals from succeeding.