Insurance fraud refers to all types of activities committed with wrong intention of fraudulently obtaining payment from insurers. Majority of times, insurers obtain fraudulent claims from people, running into billions of dollars on yearly basis. In the recent few years, health insurance fraud has become severe problem and big challenge in front of different health-care system of United States. The reason for this is that insurance agents involved in health systems of United States are bearing huge cost because of frequent increase in the numbers of fraudulent health and medical claims. Insurance fraud can easily take place in private and in public sectors. Especially, health care programs conducted at public sector level as if for instance Medicaid and Medicare are highly conductive towards different types of fraudulent activities. One of the major reasons for this is that majority of health insurance companies operate on fees for suitable service structure.
Types of Fraudulent Activities
Now, let us have a look over different types of fraudulent activities, which will go on in insurance sector. These incorporate
Upgrading and up coding of different types of insurance services. This implies billing for more amounts as compared to actual or original offered services.
Insurance claims and billings for all types of treatments, which are not compulsory based on medical advices or suitable medical treatments.
Medical insurance or health insurance fraud also incorporates scheduling of additional visits for patients.
After this, medical insurance fraud may even incorporate referring of patients to another doctor or health expert unnecessarily.
Lastly, fraud in the health and care sector includes billing for different types of services with the objective of accompanying members in the family.
Solution to Prevention of Fraud
With the increase in medical insurance fraud in different cities of United States, insurance companies have started installation of RA7 fraud detection system provided by reputable company named Nemesysco Limited.
-RA7 uses the mechanism of conversational scripts designed carefully to give suitable guidance to agents with the help of expected scenarios. Professionals have custom made all these scenarios for effective implementation of systems by considering type of risk individuals can face and needs of investigation units.-
Installation of RA7
Evert project related to RA7 starts by preparation and scheduling of meeting designed to gain knowledge about exclusive needs of organizations. Meeting plays an important role in preparation of suitable ground for combined wok and ways, in which RA7 can fulfill expectations. Just like people are using the common mobile accessories such as Iphone speakers, Bluetooth headsets, keyboards etc, similarly there are many departments who are making the use of RA7.