When it comes to home healthcare, fraud and theft are major areas of concern. Every effort must be made to prevent fraud and theft, as occurrences not only affect the well-being of patients, but can also harm a client’s reputation.
Health care fraud occurs when false information is represented as truth. Perpetrators exploit patients by entering into their medical records false diagnoses of medical conditions they do not have, or of more severe conditions than they actually do have. Then bogus insurance claims can be submitted for payment.
Home healthcare fraud claims also involve intentional incorrect billing of Medicare. According to the Senior Medicare Patrol (SMP), “An estimated $250 million is lost to purposeful health care fraud each year.” Examples of fraud that may occur include:
As an agent, your clients may be asking about their insurance rates: “Why did my insurance premium go up? , or “Since I have never had a loss, why didn’t my insurance rates go down this year?” Insurance rates, for the most part, have gone up anywhere from 6% to 15%. There are a number of reasons for this increase.
A “Hard” Market
After about five to six years of a “soft” market, we are starting to see the market turn “hard”. Mortgage rates and government bond rates have hardly ever been as low as they have been for the past few years. Previously, when government rates were in the five to seven percent range, insurance companies were able to offset the claims they were paying out by parking a percentage of their premiums in these bonds, which in turn, helped keep rates low. Now, with government bonds yielding barely one percent, insurance companies no longer has that cushion to help with insurance claims.