About Insurance Fraud

There are a number of ways that some unscrupulous treatment centers are defrauding insurance. Insurance fraud is a huge reason that insurance rates grow so high.

Methods of insurance fraud might be:

• The treatment center purchases a policy for the incoming client so that they can bill services for it.
• The treatment center bills for services that were not rendered.
• The treatment center alters dates of service in order to fit in with insurance coverage dates.
• The treatment center routinely waives deductibles or co-pays for service. These are fees that typically must be paid up front. Here’s a good article on this topic.  The only part of an insurance cover that can be billed to the client is “co-insurance” so long as the client has signed an agreement with the agency to pay that fee.
• Faking of diagnosis codes or lying during the utilization review process to gain more time for the client at a level that they may not assess for any longer.
• Prescribing and administering of unnecessary prescription drugs (for instance: prescribing a benzodiazepine for meth detox or suboxone for alcohol detox or treatment).
• Taking advantage of the client and (and a billing opportunity) by paying them to receive a naloxone or other type of implant. Implants are not bad in and of themselves; it’s the way that they are being promoted and billed that creates the potential for fraudulent promotion of them.