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.
ALL of the above practices are fraudulent, certainly unethical, and they cause increases in health care costs.
- Addiction Treatment Facilities’ Medical Director Sentenced in $112 Million Addiction Treatment Fraud Scheme
- Medical Director Convicted in $110 Million Addiction Treatment Fraud Scheme
- South Florida Addiction Treatment Facility Operators Convicted in $112 Million Addiction Treatment Fraud Scheme
- Mass.gov notice on avoidance of treatment scams
- Big bust: 52 million dollar scheme.