US & UK Combat Health Insurance Fraud

Health insurance fraud is a problem across the world and ultimately it affects the average customer because it forces up medical insurance premiums. But now there could be hope for an international effort to combat it.

British health insurance companies have signed an agreement, a Memorandum of Understanding, with US companies that aims to tackle healthcare fraud in the UK, US and across the world. One of its functions will be to share information and systems will be set up in order that incidences of fraud can be reported. Another aim of the agreement is to raise international awareness of the issues involved.

Health insurance fraud is:

'Intentional act of deceiving, concealing, or misrepresenting information that results in health care benefits being paid to an individual or group.'

Fraud can be committed by both members, providers and brokers. Private medical insurance members can defraud in many ways including the deliberate concealment of pre-existing conditions and not declaring other types of cover.

Providers can defraud health insurance companies by charging for unnecessary or unauthorised treatments.

The UK has The Health Insurance Counter Fraud Group (HICF) which is an industry led organisation whose aims are to counter health care and health insurance fraud. They have eleven members:

PruHealth
AXA PPP healthcare
BUPA
Aviva
WPA
Standard Life Healthcare
Exeter Friendly
Groupama
CS Healthcare
Simply Health
CIGNA

The HICF moto is: 'It is Fraud to conceal fraud'

Their website depicts several fraud case studies which show the breadth of the problem including a case where a GP lied to an insurance company about a patients cancer claim. The GP supported the patients claim that their cancer way new wheras in fact the GP has been investigation the patients for cancer for quite some time.