4 Medical Fraud Horror Stories—And How You Can Protect Your High-Net-Worth Clients

Medical fraud is occurring more frequently than ever, and it can be especially harmful for your high-net-worth clients. Here are situations that occur all too often—and how your wealth management or accounting firm can step in to provide protection.

Not all instances of healthcare fraud are intentional. Medical billing, in particular, is remarkably complex, and honest mistakes do occasionally happen. But there are, unfortunately, numerous individuals and groups who will quite willingly take advantage of this complexity and use it as cover while they defraud your clients. 

Let’s discuss some of the most common types of fraud, and how they can impact your valued clients.

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Fraud Cases Are Increasing, And Your Clients Are at Risk

These stories all have one thing in common: While the authorities eventually caught on, the fraud itself dragged on for months before any action was taken. 

Why is this?

Because no one was monitoring the victims’ healthcare transactions. Keeping a careful eye on insurance exchanges and bills could have caught many of these problems before they spiraled into potential arrests and millions of lost dollars. 

In 2017, a full 30% of those who had their medical identities stolen had no idea when the theft occurred. Victims often discover the fraud only when they try to obtain medical care, when they may be informed that they have exceeded their benefits, or have outstanding bills to pay, or have received someone else’s diagnosis. 

Health insurance companies should be the first line of defense, but they are not incentivized to spend their own resources following up on every healthcare transaction they facilitate. Further complicating matters is the sheer complexity of the industry. 

It is extremely difficult for the average individual to determine whether or not a procedure or treatment has been properly coded on an insurance billing statement. So overbilling and fraud often go unnoticed.

Because statements and explanations of benefits are difficult for the layperson to read, they often take whatever is on them at face value and make whatever payments are required. Unfortunately, fraud rarely stops there; bad actors are eager to continue exploiting health insurance plans, and beyond that, your wealthy clients. 

The current atmosphere presents your wealth management or accounting firm with a unique opportunity. You already handle financial matters for your clients. Their medical data is just as valuable—if not more so; why not increase the value you offer to them by managing their medical bills and protecting their medical privacy?

Partner With Experience to Protect Your Valuable Clients–and Save Time For Your Staff

By offering protection of their medical data and guarding them against fraud, you are potentially sparing your clients from embarrassment and financial consequences. Fully protecting them, By By offering protection of their medical data and guarding them against fraud, you are potentially sparing your clients from embarrassment and financial consequences. Fully protecting them, however, requires a deep understanding of the healthcare industry and its laws and regulations, which can change frequently.

Spare your current staff the need to learn an entirely new industry. Instead, protect your clients the right way by partnering with a company that has made medical billing and fraud its chief priority. These experts are already well-versed in billing coding, health insurance, and the various transactions that comprise today’s healthcare; there is no need to invest in expensive, time-consuming training of existing staff, who would otherwise have to split their duties.

These experts provide a stout line of defense for your clients by maintaining meticulous monitoring of their healthcare transactions. By thoroughly auditing all bills and explanations of benefits, they are able to get ahead of the hidden overcharges and transactions that can signify fraud and eventually spiral into millions of lost dollars. 

By leaving these matters to the experts, you’re doing your clients a remarkable service. “Those who operate full-time in this industry are trained to spot fraud,” says Scott Speranza, CEO of InAssist, a company specializing in medical protection for high-net-worth clients. “They speak the language of the industry, and can act on your clients’ behalf to help protect them from fraud and overbilling. By letting them handle the heavy industry lifting, you’re giving your firm a competitive edge.”  

Speranza knows what he’s talking about; in the last 10 years, InAssist has saved its high-net-worth clients over $130 million that would otherwise be lost to medical bill fraud and overbilling, largely in part due to its monitoring of medical transactions and willingness to take the fight to insurance companies or healthcare providers. 

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Your Clients Deserve Top-Notch Service and Protection

Think of these partners as extensions of your wealth management or accounting firm. They may be experts in their industry, but they are also experts in the care and management of high net-worth families and individuals. They know exactly what’s at stake for your clients, and they will offer the same white-glove service you already do.

Your clients are absolutely worth protecting. Instead of attempting to take on the entire healthcare industry yourself, team up with those who have already battled with it—and won.