Search This Blog

Wednesday, January 23, 2008

Health insurer oversight not underinsurance: Health insurance fraud

Well Care Health Plans in Florida is the subject of an ongoing fraud probe. While it is unclear how the State and Federal investigators were tipped off to the fraud, it is often assumed, as far as I know that it came from some sort of insider tip or whistleblower activity. In the meantime, Well Care's contracts with the government are largely predicted to be unaffected, and therefore, the stock is predicted to do well in 2008. Like other companies who are getting new governmental contracts as our government continues to empower private business to "empower" us, these companies are making money--lots of money.

While this might seem like an example of why the government should further ignore the insurance industry, it's actually the opposite. Private insurer health insurance fraud is directed to state agencies (specifically departments of insurance). Rarely if ever would you hear of federal and state agents bursting into offices of private health insurers (without government contracts) to seize evidence such as was done with Well Care. Governmental connection via getting dollars actually adds a tier of protection for consumers. Opting out of the minimal oversight that already exists is stupid. Oversight needs to be increased, not premiums. Instead of paying subcontractors to keep track of gym attendance, insurance companies should be overseeing the money paid to providers, obtaining confirmation from patients that services billed were received, and auditing their own books. Instead, we're being told that it's the sick who are increasing the cost of health care. Really? You better check those fraud figures and see how much is estimated to pay for fraud.

Oversight of insurance companies should not be defensive only (in response to an allegation). Go to any health insurance fraud reporting website and examine how the basic tool is based on individual allegations. This dependence on individuals reporting cases where they are double-billed by providers, billed for treatments, medications and services that were never received and/or never occurred is a big problem because once alleged fraud is a long bureaucratic process that normally results in a fine being paid by the company that barely impacts the company and then the company goes on doing business. So I anticipate the case will be with Well Care.

In spite of the fraud probe, Well Care's business and its governmental contracts are expected to be unaffected. Its profits are predicted to rise (do a search and come to your own conclusion).

What is important is that those against universal health care should stop addressing the issue as why fix what's not broke. There is not an "American" small town group of insurers competing in the open market-place so that American consumers can support those health insurers who answer their needs. We have a hybrid system of a few key players who compete for governmental contracts to provide Medicare and Medicaid, who compete for employer contracts and who compete with one another to cover less for more dollars--that's without the fraud element. Then, when fraud is alleged, we rely on individuals (and remember, they're sick and getting treatment and maybe unable to determine that they are being double-billed or falsely billed as they struggle through bureaucracy and paperwork).

Task a day insurance: Do you really know what you and your insurer were billed for? If not, go over your statements. Complain to your state insurance department or state insurance commissioner. It will take months, your state will probably conclude the insurer is fine and the cost of fraud will be handled next year when your premium is raised--is that American?