# Insurance fraud: any of my business?

**URL:** <https://boards.straightdope.com/t/insurance-fraud-any-of-my-business/697550>\
**Category:** In My Humble Opinion\
**Created:** [September 5, 2014, 4:07am UTC](https://boards.straightdope.com/t/insurance-fraud-any-of-my-business/697550 "2014-09-05T04:07:46Z")\
**Posts on this page:** 3\
**Page:** 2

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**Author:** ![alphaboi867](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/alphaboi867/32/3898_2.png) [@alphaboi867](https://boards.straightdope.com/u/alphaboi867)\
**Post date:** [September 7, 2014, 2:49am UTC](https://boards.straightdope.com/t/insurance-fraud-any-of-my-business/697550/21 "2014-09-07T02:49:42Z")

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> [@susan](#):
>
> Improper billing is insurance fraud.

Fraud requires intent; improper billing due to incompetence is Waste (still a big deal for CMS).

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**Author:** ![Mr\_Downtown](https://avatars.discourse-cdn.com/v4/letter/m/8e8cbc/32.png) [@Mr\_Downtown](https://boards.straightdope.com/u/Mr_Downtown)\
**Post date:** [September 7, 2014, 3:44am UTC](https://boards.straightdope.com/t/insurance-fraud-any-of-my-business/697550/22 "2014-09-07T03:44:10Z")

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> [@GrumpyBunny](#):
>
> If they try to bill you, point out that those are non-covered and you don’t have to pay based on the contract with your insurance company.

How would I, the patient, know what specific services are covered and which aren’t? In addition, there’s never any listing of the procedures/services on offer to be performed, and therefore no chance to decline the ones not covered. The tally of services rendered and their prices is made long after I’ve left the office.

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**Author:** ![Rachellelogram](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/rachellelogram/32/8689_2.png) [@Rachellelogram](https://boards.straightdope.com/u/Rachellelogram)\
**Post date:** [September 7, 2014, 1:07pm UTC](https://boards.straightdope.com/t/insurance-fraud-any-of-my-business/697550/23 "2014-09-07T13:07:02Z")

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Yes, it’s fraud. Truth is, there are shady doctors and lawyers are all over the place. It’s best to shut them down whenever possible. Insurance fraud does increase everyone’s premium, and that’s worth fighting against on its own. But the real problem comes in when you get a group of fraudulent claimants together who are represented by shady lawyers who get shady doctors to sign off on their injuries. A lot of times, reporting a shady clinic can bring down a whole \*ring \*of fraud. A place willing to engage in billing inflation (what’s happening to you) may be doing worse stuff behind-the-scenes.

I took some classes about insurance fraud from NICTA when I worked at an insurance company. It’s really interesting stuff! The NICB (National Insurance Crime Bureau) combats these kinds of crime in the US. Here’s a webform that you can fill out if you suspect insurance fraud:

[https://www.nicb.org/about-nicb/report-fraud](https://www.nicb.org/about-nicb/report-fraud)

Here’s a [couple](http://www.wptv.com/news/insurance-fraud-ring-busted-operation-sledgehammer-leads-to-dozens-of-arrests) [links](httP://denver.cbslocal.com/2014/05/22/insurance-fraud-ring-busted-by-colorados-attorney-general/) to busts I was able to find from a quick google search.

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