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Health Care Fraud More Likely During the Holidays

Armen Hareyan's picture

Health Insurance Fraud

Consumers are advised to take charge and protect themselves from health insurance scams.

Regence BlueCross BlueShield of Oregon, the state's largest health care insurer, is encouraging consumers, especially seniors, to be aware of fraudulent activities and to take steps to protect themselves from becoming victims of fraud this holiday season. The company offers several suggestions for how consumers can avoid falling for scams and frauds.

"We often see an increase in criminal and fraudulent activity of all kinds during the holiday season," said Alex Johnson, senior manager of the Special Investigative Unit at Regence. "People usually feel more generous during the holidays, and they're in the spending mode. Criminals take advantage of this."

In 2004, the Centers for Medicare & Medicaid Services stated that approximately $85 billion, five percent of the $1.7 trillion in United States health care expenditures in 2003, was lost to fraud. According to the National Health Care Anti-Fraud Association, an estimated $100 million is lost every day on health care fraud.

Johnson, a former FBI special agent focusing on white collar crime investigations as well as a member of the board of governors for the National Healthcare Anti-Fraud Association (NHCAA), oversees the fraud investigations unit for Regence. Regence fraud investigators uncovered nearly $7.5 million in fraud dollars in 2004.

"We are all hurt by insurance scams," said Johnson. "As health care consumers, we all end up paying the price for fraud. Health insurance fraud perpetrators are basically stealing from consumers who are paying into the insurance system. Whether it's a doctor charging for a procedure that wasn't actually administered or a phony insurance agent selling fraudulent insurance to a senior citizen, the cost of fraud ends up being passed on to consumers."

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Johnson is quick to point out that the majority of health professionals are honest and ethical. "Unfortunately, however, the small percentage that makes up the dishonest minority is costing the system billions of dollars every year," he said.

Seniors May be Especially Vulnerable

Senior citizens may be especially vulnerable to health insurance scams this holiday season because of enrollment in the new Medicare Part D prescription benefit.

"Seniors are being solicited by numerous companies to enroll in the new Medicare D program," said Johnson. "As they're looking into all of their options, seniors need to be very conscientious in protecting their health care information, and be careful to enroll only in legitimate programs."

Johnson says that protecting your health insurance information is just as important as protecting your credit card information. He also points out that it's very important to take the time to ask questions and to not feel pressured to make a quick decision. "Medicare D open enrollment doesn't end until May 15, 2006, so there's still plenty of time to look into things," he said. "Ask what company an agent is associated with. Take the time to check out that company or agent to make sure they're registered."

According to the FBI's Web site, seniors are particularly targeted for fraud for several reasons.