Essay about The Problem of Insurance Fraud - 1462 Words

Fraud is common among many aspects of society, one of the most prevalent types of fraud is insurance fraud. The fraud occurs on both ends from the insurer, to the people who use insurance including the physicians and the patients. A frauds usually cost Americans about thirty billion each year, which is a high cost for the amount of the money that those involved in the fraud often get from insurance (ORourke, 2003). For example, In 1995 alone one trillion were spent on health care, and 10-15 percent of that payment was comprised of health insurance fraud (Skeen, 2003). What is more, insurance fraud is often placed in two categories, hard and soft fraud, where hard fraud is the willful of a person to commit the fraud†¦show more content†¦There was a particular case that stood out, which involved the willful act of a physician to commit hard fraud against his patients. In this case, a health insurance company, Instant Mutual, called stating that one of their clients were complaining of their bill, stating that it was unreasonably high. The client had been sick for a while, and stated that she had been visiting a gastroenterologist for the treatment for Irritable Bowel Syndrome (IBS). The client had been referred to a gastroenterologist, Dr. John Spirolact , by her primary care physician, Dr. Codonea. Dr. Spirolact had practiced for about twenty-five years, and was known for his treatment of diseases like IBS, Crohns disease, and ulcerative colitis. The insurance company stated upon speaking with the doctor a few days later, he stated that he was treating her for symptoms of Crohns disease, which has similar symptoms to IBS, but is far more severe of a disease than IBS. As a result, the doctor mentioned that it was necessary to schedule three colonoscopies that month, as well as an ultrasound to test for inflammation, and prescribe her five more medications that he stated were common for treating symptons of the disease, sulfasalazine, urssodiol, budesonible,inflixmab and flagyl,Show MoreRelatedEssay about Workers Compensation Fraud1575 Words   |  7 PagesWorkers Compensation Fraud Workers Compensation is a service that provides reimbursement for lost wages to employees who have sustained injuries from work or work-related tasks. It is also one of the services that is most often the victim of fraud. Each of the three types of fraud, claimant, employer, and provider, is defined by the same characteristics, outlined by the Ohio Board of Workers Compensation: #61623; Receiving workers compensation benefits that are not entitled to the claimant; Read MoreCurrent Health Care Issues1459 Words   |  6 Pagescontinues to rise each year. 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