Everyone knows that the health insurance protection industry is continually raising monthly premiums, and many feel this is unjust to you as the consumer. However, the health insurance cover industry has had to fight increasing health insurance fraud. The amount of money spent on investigating and prosecuting fraud is then passed on to policyholders. Many people do not know what health insurance cover fraud entails, though. With reports estimating health insurance deception is a $30 billion to over $100 billion industry per annum, the topic ought not to be taken gently. Every health insurance policyholder should realize what health insurance cover fraud is and its consequences. By doing so, you are more able to realize and fight fraud.

Health insurance deception is typically termed as intentionally deceiving, misrepresenting, or concealing facts to receive benefits from the insurer. Essentially this implies that you assert that you paid for certain medical procedures or expenses out-of-pocket that you have not actually received, and you are submitting claims to the insurance firm to receive reimbursement. Another instance of member fraud is to conceal prior conditions or to alter medical documents so that non-policyholders or ineligible members receive medical benefits under your policy. Perhaps your sister does not have insurance and needs medical assistance. Having her use your name and policy to cover the costs is health insurance cover fraud. While you may think that this is a small issue in comparison to your sister receiving remedy, it is actually very serious to your health insurance cover company and industry, and will results in fines and possible imprisonment if your are caught.

Not just policyholders commit fraud, but providers (physicians, hospitals, etc.) do as well. Since physicians and hospitals bill the insurance firm for services they provide for you, they are likewise receiving reimbursement from the insurance firm. When providers commit fraud, they may be billing the insurance firm at higher rates for services rendered or they may bill for services you never received. In these instances, you will in all probability be asked to cooperate in the insurance company's investigation.

Another sort of health insurance fraud that has developed recently targets the policyholder more than the insurer. Schemes have developed where fake insurance companies or agents sign unsuspecting customers for coverage at surprisingly low premium rates. They often times act very much like a regular underwriter for the first few months, paying for smaller medical claims like physicians visits. But once you have a more severe medical problem that needs remedy, the insurance company will disappear - together with the money you have been repaying in premiums.

The rule with health insurance protection deception is much like that of any other scam: if a deal seems too good to be true, just don't forget - it in all probability is. Remember to be honest in your dealings with health insurance protection businesses and expect the same in the return from all of these companies, along with your health care providers. Stay legal to avoid fines and prison and to carry on receiving health insurance cover cover.