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How Health Insurance Fraud Leaves Corporations with Billion-Dollar Losses

medical document Health Insurance Fraud is Not a Victimless Crime

Health insurance fraud continues to take its toll on a number of industries across the United States. While many businesses use health insurance plans to attract top talent and keep their staff healthy, these insurance plans continue to be abused by their employees. Fraudulent health claims are unfortunately all too common, as employees continue to stretch the truth regarding the claims they make and the nature of their relationships.

Some health insurance fraud examples include employees lying about their marital status, long-term relationships, or sharing benefits with a spouse despite being recently divorced. In other cases, some employees lie about the age of their dependent children, continuing to claim benefits despite their children “aging out” of their policies. While employees might feel these white lies are harmless, they are committing serious health insurance fraud that is costing their employers a small fortune. Further, this type of fraud is criminal and could lead to arrest and jail time.

Employers have been, for years, unable to address these challenges, as the personal information of their employees is often not shared with an employer.

How Much is Health Insurance Fraud Costing American Corporations?

As employees of major Fortune 500 companies remain challenged by fraudulent health insurance claims on behalf of their employees, it is estimated that, according to the National Health Care Anti-Fraud Association (NHCAA), approximately $68 billion is lost annually.

The exact numbers behind such losses are difficult to determine, as many corporations simply cannot document and respond to every potential instance of fraud.

Piggy Bank with Mask Health Insurance Fraud and Potential Consequences

Aside from the obvious financial consequences of health insurance fraud, it is a crime that can result in imprisonment. While it has become common among workers to stretch the truth in regards to their benefits, this fraud hurts more than just the businesses providing health insurance. Fraudulent claims can, over time, raise premiums, clog up the healthcare system, and waste the time of professionals who could be focused on providing care to those who truly need it most.

Health Insurance Fraud in the USA: What Solutions Exist for Businesses?

Many industries have had difficulties preventing and investigating instances of health insurance fraud. Many employees, especially those who have worked for a single company for extended periods of time, react negatively to inquiries about fraudulent claims. Requesting information regarding an employee’s marital status or the age of their children might be considered invasive, with employees denying an employer’s request.

Oftentimes, health insurance investigations conducted on behalf of an employer can prove to be ineffective, yielding inconclusive or partial evidence. At other times, many corporations have encouraged employees to police one another, offering tip lines for reporting suspected insurance fraud. With losses piling up, there is a dire need for new and innovative solutions to bring these fraudulent claims to a halt.

Stethoscope and Computer Health Insurance Fraud Addressed by ISB Global Services

ISB Global Services have worked to ensure that workforces across North America are built upon honesty and integrity, offering comprehensive background check solutions for employers of all kinds. ISB is now offering Eligibility Monitoring solutions that are less invasive than previous avenues for addressing health insurance fraud in the workplace, helping to put an end to fraudulent claims before they cost extended losses to an employer.

By leveraging ISB’s unique access to information and national databases, ISB can spot instances of fraud and reduce losses attributed to false claims by up to 80%. Such efforts to prevent health insurance fraud can help businesses maintain their bottom line and promote greater levels of integrity among their workforces.

Should your business suspect that workers are taking advantage of health insurance programs in your workplace, contact ISB directly by emailing Elvin Croswhite at [email protected].
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