About Us
Since 2000 BCSI has performed hundreds of successful investigations.
Our integrated team of investigators and support services ensure that the investigations are conducted in a timely fashion with leading edge techniques.
BCSI is considered the platinum standard of the industry based on the quality and the wide spectrum of its services as well as the expertise of the investigators.
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How Insurance Fraud is Committed
Part-two of our four-part series examining health insurance fraud takes a look into how this fraud is committed and the parties who are responsible for the crime. While health insurance fraud can be committed many different ways by numerous players the most frequent are the plan members and health service providers.
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Plan Members
Insurance fraud is most often committed by the employee receiving the health benefits, also known as the claimant. While there are countless methods criminals are using to commit this fraud some of the most common are as follows: Often they will exaggerate an ailment in order to receive more paid time off work or claim they can only work with restricted duties. Furthermore, a claimant may allow someone else to use their insurance coverage and falsify records to receive a claim for an ineligible dependent. As well, a plan member may also attain a completely legitimate claim and then alter the date and submit a second claim to attain double the amount of their original claim.
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Health Service Providers
However, fraud can also be committed by the doctors or health service providers who treat the claimants. This can be done by falsifying bills to include services that were not provided to the member. For instance, if a member has coverage for a massage, they may utilize a facility that offers a multitude of services and instead get a manicure. The service provider will then falsely create a bill for a massage, which the employee will submit for reimbursement to their insurance provider.
Other typical examples of fraud include making diagnosis that they are not licensed to make so that their practice is reimbursed. As well, producing a bill for a higher level of service. Thus, when the employee submits the claim for reimbursement the company gets paid more than what their service was worth. Health benefit providers has also been caught performing unnecessary services, and in some cases surgeries, in order to receive financial reimbursement.
Criminals
Health insurance fraud can also be committed when a criminal steals your healthcare information and uses your plan to submit claims for monetary gain.
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Contact Us
BCSI has the skills and resources to investigate health
insurance fraud. Please feel free to contact our offices at 604-922-6572 for a free consultation with one of our lead investigators and learn how BCSI will assist you in developing a personalized investigation strategy to mitigate insurance fraud.
Be sure to read the next installment of the newsletter which will focus on who is affected by health insurance fraud, and it's not just the insurance companies.
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