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Insurance fraud is defined as any act committed with the intent to fraudulently obtain payment from an insurer. A big chunk of the total claims received by insurers are fraudulent claims that run into billions of dollars annually. Health Insurance fraud is today a very serious problem and a great challenge, as it has proved to be very costly to the U.S. health-care system

Insurance fraud is in the public and private sectors. It is known that our public health programs like Medicare and Medicaid are especially conducive to fraudulent activities, as they are often on a fee-for-service structure. One can not forget the case of the New York doctors who in the past have been committed 60 insurance companies and a city transit agency of at least $ 15 million through clinic billing scams and were later to be behind bars.

What are the types of fraudulent activities that dishonest doctors and health facilities are known to be in? The activities include,
# Up-coding/Upgrading (accounting for more than the actual service)
# Delivery and settlement of consequence that treatments are not medically necessary
# Scheduling extra visits for patients
# Referring patients to another doctor unnecessarily
# Billing for services to their accompanying family members
# Ordering unnecessary tests

With newer and better coding and techniques, and new strategies are always strong enough to the ailing U.S. health care. It is hoped that after the November 2008 presidential elections, the future will bring a better reform with less fraud, and the efficient and effective health insurance for the entire population in the United States.

The author of this article is Ricci Mathew of Outsource Strategies International (OSI), a U.S. based company that offers services in Medical Coding, Medical Billing, Medical Transcription for clients across the U.S..