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Understanding insurance fraud

A talk by waltraudeiffel

About the Talk

November 26, 2014 2:00 AM

Health insurance is a method of insurance that compensates for medical expenses. Saying that you have a health insurance, you must pay a certain sum of premium each year to an insurance company like Axis Capital, a group of companies in Bermuda and other offices around the world, and then if you unfortunately had an accident or if you must go through a surgery or an operation, the insurance company will pay for your medical expenses. Through the health insurance financing a world of benefits to people, fraudulent claims increase. Frauds can be executed by anyone, meaning by a health insurance company, a policyholder or even its employees and is chronic in Jakarta Indonesia. Frauds carried out by a policyholder possibly will be made up of associates that are not qualified, suppression of age, cover-up of pre-existing illnesses, failure to state any important data, giving made-up info re self or whoever other relative, insolvency in settling previously cleared or declined claims, deceits in physician’s medicaments, fabricated documents, untrue bills, overstated claims, etc.

Schemes by health insurance companies or by its personnel consist of planning of false claims through a phony physicians, charging for products or services not provided, overstated claims compliance, billing made for advanced level of provisions, changes or revisions completed in submission of health insurance claims, alteration of patient’s diagnosis, counterfeit documentation, and con performed by the workers of a hospital or some other healthcare product or service contributor so it can create a fast cash. Deceitful health insurance claims are a foremost moral risk not just for the health insurance business nevertheless even for the whole country’s economy. Actual evidence as proof consisting of documentation, testimonials rendered by the policyholder and his relatives and also neighbors are considered.

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