How to Stay Away from Health Insurance Fraud

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Maybe health insurance fraud topic seems to you quite a shock thinking that nothing related to this aspect could lead to a fraud, but you would be surprised to know that this issue is more prevalent than you think. The thing is that you should know about this as you would rather not become a victim considering that this issue can not happen to you, let alone believing in its existence.

You can count among those people who look toward this matter with some susceptibility, never suspecting that this might happen to them until one day when they must present their medical provider the health insurance policy and realize that they can nit make the claim as long as the policy is not valid.

Since it is very hard to prevent this situation from happening once you have turned already into a victim of health insurance fraud, there are however some measures that you can take in order to prevent this from happening before you purchase the health insurance policy for you.

The secret lies into being very cautious when you are out there looking for health insurance offers. The offer that looks quite good, in fact too good to be true, is more likely to be a fraud.

What means too good to be true in this given situation? In most cases, this means low costs for rates presenting also excellent health benefits package or coverage, all these being promoted by insurance companies that are unfamiliar and boast with discounted prices that can not be real in the health insurance policy market.

You should be accustomed with the fact that a company for being selected needs to have gained its reputation becoming in this way trustworthy, but if the company you come across is not reputable, then you should take more of your time and do some extra research on checking the local State Insurance Commission.

They should tell you whether to trust your money to the chosen health insurance company letting you know about its legitimacy into selling health insurance policies within your state. Nevertheless, it is recommended for you to check on each offer you are presented, reading as well the fine print to see if there are any hints to lead you believe that this can be a health insurance fraud.

In case you become the victim of such a fraud, you are entitled to file a health insurance fraud complaint with your state insurance regulator. Along with this procedure you should alert the authorities in question to prevent others from falling victims to the specific health insurance fraud.

Nowadays’ consumers have confronted very often with this sort of issue being thrilled to have found very convenient terms of a health insurance policy. This is why it is recommended to always research and compare the providers although this might take few more minutes of your time.

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  1. What Is Guardian Life Insurance Trying to Hide?
    Guardian Life Insurance Company of America, through its outside counsel law firm, Leader & Berkon LLP, deposed a non-party witness, John Zaher of The Public Relations and Marketing Group, LLC. The deposition, which was sought under the guise of determining if a confidentiality agreement was violated, had no legal basis related to Dr. Berton Forman’s $12 million lawsuit against Guardian, but was instead held merely to harass and intimidate Dr. Forman and Mr. Zaher as a way to prevent them from exercising their rights to free speech and to educate the public about the tens of billions of dollars in insurance fraud that occurs overall each year.

    The attorneys at Leader & Berkon LLP — the law firm representing Guardian — sought a deposition of Mr. Zaher late last year, but, after initially granting a temporary restraining order in preventing the deposition from going forward, the court subsequently granted them a very limited deposition. On January 28, the deposition was held, during which the attorney representing Guardian continuously sought to go beyond the limited scope authorized by the court and to harass and intimidate Dr. Forman and Mr. Zaher. Meanwhile, the law firm was presumably billing Guardian at a rate of hundreds of dollars per hour. The deposition, lasting several hours, was pointless and did not deal with the facts of the case. Rather, it only served to increase legal fees to benefit Leader & Berkon and to create a chill on Dr. Forman and Mr. Zaher’s rights to free speech. Rather than stick to the issues such as healthcare fraud, Guardian’s outside counsel went on a fishing expedition, asking Mr. Zaher questions that were irrelevant to the case and outside the scope granted by the court.

    Guardian had earlier attempted to dismiss Dr. Forman’s lawsuit but the New York State Supreme Court denied the motion. Guardian later appealed the decision, which was upheld by The N.Y.S. Supreme Court, Appellate Division, First Department, finding that the suit could proceed to trial on each and every count — a major blow to Guardian and its efforts to sweep Dr. Forman’s lawsuit under the rug and proceed with business as usual.

    Dr. Forman, a 25-year veteran anesthesiologist and owner of a patent for healthcare fraud software, was engaged by Guardian over a six-year period to find overbilling and fraud on the part of doctors and hospitals, for which Dr. Forman would receive a fee of 25% of all recovered funds. Upon reviewing hundreds of thousands of claims provided by Guardian, Dr. Forman identified tens of millions of dollars in overbilling and fraudulently paid claims. He discovered that large hospital groups were, in many instances, triple billing or using incorrect codes on claims they submitted to Guardian for payment. Considering that his patented software is able to discover fraudulent billing for anesthesia, the case reveals just how rampant insurance fraud is, when you take into account other areas of medicine, amounting to tens of billions of dollars per year, according to health industry experts.

    The lawsuit alleges that Guardian failed to pursue the unrecovered monies due to its having entered into separate contracts with Preferred Provider Organizations (PPOs). Despite entering into such agreements, Guardian asked Dr. Forman to perform audits of claims from providers that were part of the PPOs’ plans. Guardian’s contracts with the PPOs effectively precluded any possibility of recovery by Dr. Forman for nearly all of the claims that Guardian asked Dr. Forman to audit.

    “This deposition was only to harass and intimidate myself and PRMG,” Dr. Forman said. “But it begs the question: What does Guardian have to hide? What is it about the case that Guardian doesn’t want its ratepayers or regulators to know about?”

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