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Insurance Fraud or Honest Mistake

June 24, 2015 by  
Filed under Blog

Our insurance system is very complicated. At times people do have problems figuring everything out and when they aren’t able to, mistakes are made. Most of the time, this happens when medical professionals and policy holders, both make costly mistakes, when trying to figure out the complicated procedures involved in medical insurance policies. This can lead them to unknowingly commit insurance fraud and land them in deep trouble.

At NSIU, we believe in uncovering the truth in every insurance scam investigation, even if the fraud occurred because of an honest mistake. So, if you find yourself in a situation like the ones mentioned below, our investigative services will be available for you. We can help you prove that the fraud occurred as a result of an honest mistake and we will gather evidence to prove the fact. Let’s look at some mistakes that can lead to a fraud charge:

Services That Weren’t Provided

This mistake can occur when someone from your doctor’s office makes a mistake and bills your insurance company for the services or procedures that you didn’t receive. This can happen when you make an appointment for a procedure but end up cancelling it at the last minute. The person in charge of the billing at the medical establishment may not realize that you cancelled your appointment and still bill your insurance company for the services. This can lead the insurance company to start an investigation, which you can get wrapped into.

Different Procedure

This happens more often than people realize; because of some clerical error or communication gap, your doctor may bill your insurance provider for a different procedure than the one you actually received. This can go unnoticed when the services cost the same, but if the billed service is more expensive than the one you received, then it can cast suspicion of fraud on you and the healthcare provider.

Double Billing

This is a common problem/mistake, which can lead to an investigation against you or your medical care provider. Sometimes, insurance companies take their time to pay the policy holder’s bills, so the billing department at the clinic will send another bill to the company. It can look like that the healthcare provider is trying to get double the payment for the procedure they provided.

These are some honest mistakes that can lead the insurance company to believe that you and your medical care providers are plotting a scam against them. So, rectify the situation like this as soon as it arises, and get in touch with us (800-960-6748) if you require the services of an insurance investigation unit.


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