Health insurance companies may have fraud departments, but few cases, if any, are actually pursued. No one at those companies is looking out for your wealthy clients—that’s where your wealth management or accounting firm comes in. Here’s what you need to know about protecting your clients when insurers won’t step up.
Today’s healthcare is entwined with and largely governed by insurance companies. It’s a health insurance plan that determines what kind of care an individual can receive, and how much they’ll have to pay out of pocket for that care. Your wealthy clients no doubt have access to the best insurance plans available, often paying high monthly premiums to ensure they obtain the treatment they need when they need it.
But the ongoing digitization of medical records and transactions means it’s easier than ever for fraud to occur. The complex world of medical billing makes it difficult for someone without years of training to spot overbilling from doctors’ offices; too often, patients just pay up.
This crime is growing; last year, Americans suffered from over $325 billion in medical billing fraud and overcharges, with high-net-worth households disproportionately affected.
Insurance Companies Often Ignore Signs of Fraud
Insurance companies are doing little to stem this rise in criminal activity. The overwhelming revenue they secure each year makes chasing after fraud cases—even those worth millions—a waste of time and resources, because the payers themselves rarely put up a fight when they see their bills.
“Few, if any, individual payers will challenge overbilling or other types of fraud,” says Scott Speranza, CEO of inAssist, a medical data protection company that serves high-net-worth clients. “The complexity of medical coding makes it a foreign language to them. They can’t tell when something is wrong. But unfortunately, you have to look at the coding to even start sniffing out fraud cases. Since the majority of payers don’t even do that, insurance companies are not incentivized to investigate potential cases.”
While most insurers are required to report suspected fraud to state regulators, only a handful of cases ever make it to the desks of authorities.
Insurance Companies Rarely Pursue Potential Fraud
Despite over $325 billion lost in medical fraud and overbilling in the last year, insurance companies often elect not to pursue potential criminals.
- In 2017 and 2018, only one insurance fraud case was filed in the state of California—a state with 40+ million people on insurance.
- In the same years, insurers in Minnesota reported two and five cases, respectively.
- A health insurance giant described “a dozen” cases across all 50 states during those two years.
When insurance companies do detect problems within their systems and follow up on them, litigation is rarely pursued due to its high cost and the public relations nightmare that can follow. A large investigation into missing fraud—accompanied by the potential discovery of incompetence—can damage an insurance company’s reputation, hence their reluctance to go to court.
Most often, insurance companies simply blacklist healthcare providers who have been caught defrauding the system rather than pursue them in court. The fraudster is left free to continue their criminal activity. Often, they can even continue with the same insurance company under different methods of identification.
If Your Clients Have Health Insurance, They’re Easy Targets
Whether fraud cases go unnoticed or simply ignored, the end remains the same: insurers tend to pass off costs to your clients. Any fraud that is going on simply continues, often undiscovered until someone needs medical care.
At that time, your clients may learn that they’ve maxed out their benefits, or have been receiving inappropriate treatments, or been misdiagnosed. In some cases, they may even have their medical identities stolen by the very healthcare providers they trust to take care of them.
That’s why it’s more critical than ever to protect their personal medical data, as fraud can impact their reputation, well-being, and wealth. These are all things your wealth management or accounting firm can take on. Because medical data has become just as valuable (if not more valuable) than financial information, it makes sense for your firm to keep it secure.
This doesn’t just benefit your clients, either; taking over medical bill payment and medical security adds even more value to the services you already offer, and gives your firm the competitive edge it needs to succeed in the digital age.
Give Your Customers The Best Of Both Worlds By Partnering With An Expert
Partnering with an expert who knows the medical industry inside and out will give your clients the peace of mind they deserve.
A company that has been in the industry for decades and can both interpret medical bills and communicate with health insurers and healthcare providers will get to the bottom of potential fraud far quicker than the insurance companies themselves.
“It’s the medical coding that prevents careful tracking of fraud. The only way to prevent and stop overbilling and other types of healthcare fraud is the careful examination of every bill and benefit. But most people don’t know what they’re looking at; you need extensive training to tell a genuine miscoding from intentional fraud.”
Scott Speranza, CEO of inAssist
It’s the meticulous study of medical bills and the codes they contain that ultimately stop overbilling and fraud in their tracks. Companies like InAssist go a step further; once problems are discovered, they can speak on your clients’ behalf, working with healthcare providers, insurance companies, and, if necessary, the authorities to ensure fraud is halted and your clients receive any necessary compensation. In addition, the company you partner with should be well-versed in HIPAA regulations to protect your firm from liability and potential fines.
Through it all, your clients never need to lift a finger. They can carry on with their lives, secure in the knowledge that their medical data is being locked after. InAssist in particular has a glowing record when it comes to fraud remediation, as it’s saved its clients $130 million over the last decade.
Medical Data Specialists Work for Your Clients, Not Insurance Companies
It’s unfortunate that our existing system is so easy to manipulate, and even more unfortunate that insurance companies continue to let overbilling and fraud run rampant. That’s why it’s so critical to seek the protection of experts.
Medical data protection specialists do not have a stake in the insurance game; they may speak the language of the insurance companies, but they are in your client’s corner. They are working for your client, providing the same excellent service as your wealth management or accounting firm.
And because they are absolute experts in this field, you can leave them to handle all of your clients’ insurance matters while your company continues to do its usual excellent work.
Sources:
https://www.propublica.org/article/we-asked-prosecutors-if-health-insurance-companies-care-about-fraud-they-laughed-at-us
https://www.propublica.org/article/health-insurers-make-it-easy-for-scammers-to-steal-millions-who-pays-you
https://www.npr.org/sections/health-shots/2021/06/28/1007198777/a-hospital-charged-more-than-700-for-each-push-of-medicine-through-her-iv
https://www.cbsnews.com/news/cologuard-unexpected-bill-colon-cancer-screening/
