Protecting assets against healthcare fraud

Affordable healthcare is an important vision for many families, even during difficult economic times. Unfortunately, like so many other things, healthcare premiums seems to cost us more each year, making this vision much more difficult to realize

To protect this valuable asset, we should be asking questions about not only our premium dollars, but also who is protecting our benefits from misuse or abuse. Carrying an insurance card is like carrying around a $2 million charge card as this is what each member is entitled to under the lifetime maximum benefit. If a member's card were used by someone else, or had benefits taken improperly for any reason, it would reduce the lifetime benefit, thus reducing the value of that asset. The unfortunate reality is that each year employers and health plans identify individuals who abuse both benefits and coverage. This is fraud and results in higher costs for everyone.

Purchasers can help overt this problem, by working with a Health plan that has a proactive fraud and abuse department. Their expertise is vital to protecting future healthcare dollars and benefits from loss or theft. Active and effective training programs for health plan staff around the identification of potential benefit fraud or abuse is one of the core components of an effective program. The sole purpose of these departments is to uncover abuses in order to protect assets on behalf of the health plan members. Special Investigations Units are an integral part of these departments and provide proactive protection of member benefits, ensuring only eligible members and dependents are accessing benefits on the appropriate health insurance policy. Unusual claims and billing patterns are closely scrutinized to ensure the appropriate benefits are applied, and healthcare dollars are spent responsibly.

While health plan fraud and abuse staff can mitigate potential fraud and/or abuse, health plan members should consider their health benefits as a financial asset and be diligent in protecting them as they would they bank accounts. Members who experience unusual claims activity, a lost/stolen card, or suspect fraud or abuse on their account, should immediately report this activity to the fraud and abuse department of their Health plan. This proactive effort from members can help minimize or eliminate the chance of benefit loss for themselves or their family.

Protecting healthcare dollars from inappropriate use can result in significant savings for the membership of a health plan. This savings often translates to lower administrative cost which can mean lower premiums. It's up to each of us to learn more about healthcare fraud and abuse and how we can protect ourselves and our benefits from this silent thief.

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