Medical Insurance Fraud: How Wealth Management and Accounting Firms Can Protect Their Clients

Over $325 billion is lost to medical billing fraud and overcharges each year.

The clients of your wealth management or accounting firm have become prime targets for these crimes. It’s time to take action: you can bring incredible value to your clients by protecting their medical privacy. 

In the last year alone, Americans have lost over $325 billion to medical billing fraud and overcharges. Medical fraud is now one of the fastest-growing crimes in the country; unfortunately, it’s also one of the most difficult to track and prosecute. 

Consider the following: In 2017 alone, some 30% of medical identity theft victims had no idea when the actual theft occurred. In many cases, their identities were used by thieves over the course of months or years, racking up hundreds of thousands or even millions of dollars.

Wealthy individuals like your clients shoulder a disproportionate amount of these thefts.

Wealthy individuals like your clients shoulder a disproportionate amount of these thefts. Their high net worth has made them a target for various types of thieves over the years. Today, it is their vulnerable medical information that makes them uniquely interesting to fraudsters. Your clients likely have excellent health insurance plans, which puts them squarely in the sights of those who want to use the medical system to turn a profit.

These types of crimes take many forms, but these three are the most common:

• Medical identity theft: Thieves use your clients’ health insurance and identity to obtain medical care for others.
• Healthcare fraud: Healthcare professionals charge your clients’ insurance for services and drugs that are not actually provided.
• Overbilling: When a healthcare facility, or someone within it, accidentally or purposefully attaches a higher price tag to a service in an effort to obtain more money. Often your clients unknowingly pay the difference.

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The Highest Cost of Medical ID Fraud Isn’t Monetary

The immediate consequence of medical fraud is usually higher bills, but medical identity fraud can also lead to inaccurate records being attached to a patient’s digital medical footprint. 

This, of course, can be a forerunner to missed or incorrect diagnoses, incorrect prescriptions, and life-threatening health problems. To compound the issue, those who should be responding most vigorously to these crimes—the health insurance companies—aren’t doing much. Most have a fraud department, but these work slowly, and often need to be prodded into action. 

Your clients need protecting now—before fraud can occur. That’s why managing their medical bills and protecting their medical information is a natural expansion of your services.

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Bringing Medical Protection In-House Poses Unique Risks

But monitoring your clients’ health insurance transactions is no small order, according to Scott Speranza, CEO of InAssist, a health management solutions company specializing in high-net-worth clients. “Anyone tracking insurance claims and challenging fraud needs to understand billing codes—and there are thousands upon thousands of those,” Speranza says. “Medical billing isn’t just something you can teach yourself or pick up in a couple of hours. If you’re going to challenge a bill, you also need to know how health insurance works, and how to talk to both health insurance employees and healthcare providers. In short, you need a lot of time-consuming and expensive training.”  

And if you do bring monitoring in-house, you risk running afoul of HIPAA and the HITECH Act, which can have expensive consequences. Beyond that, your employees will end up splitting time between their original duties and dealing with insurance companies, effectively cutting back on the attention they usually give your clients.

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Partnering With Experts Protects Your Clients and Your Firm

In truth, you’re doing your high-value clients and your own firm a disservice if you try to train your existing employees to deal with insurance matters. Whoever takes up the duty of protecting your clients’ medical privacy must be familiar and comfortable with billing and coding, communicating with medical directors and medical boards, and possess a general understanding of medical needs and how the industry works.

The most expedient answer is to partner with a company that innately understands this industry. Your clients need and deserve a protector that speaks the language of the healthcare industry. Speranza’s company, InAssist, has saved $130 million for their clients who might otherwise have been victims of medical fraud and overbilling. 

InAssist has saved $105 million for their clients who might otherwise have been victims of medical fraud and overbilling. 

There are numerous other benefits that accompany this type of partnership. By letting an expert take on this task, your staff can focus on the things they were hired to do. You’re also spared the need to hire and/or train additional staff members, allowing you to maintain the excellent service your clients value so deeply.

Blend Expert Fraud Protection With White-Glove Service

Your clients are accustomed to the exceptional service you provide. One of the most critical qualities of any medical protection firm you partner with will be their ability to match or exceed your level of service. 

The right company will seem like a perfect extension of your wealth management or accounting firm, bringing the same care and respect to every interaction they have with your clients. In short, they’ll be both a continuation of and a credit to your existing services. 

What’s going to make your clients stickier and your services more valuable? Constant innovation. Partnering with a medical protection specialist gives you another valuable service to offer potential clients as the world grows ever more digitized and these crimes continue to proliferate. 

Your clients already trust you with their wealth. As we expand into the digital era, consider asking them to trust you with their medical information. Make sure you’re providing the type of service your clients expect and deserve by partnering with a company that will bring the same care and attention to protecting their medical records.