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You can peruse Medicare fraud prosecutions for all kinds of scenarios. See for example https://www.justice.gov/archives/opa/pr/doctor-sentenced-54m-medicare-fr
by SpicyLemonZest 2y ago
You can peruse Medicare fraud prosecutions for all kinds of scenarios. See for example https://www.justice.gov/archives/opa/pr/doctor-sentenced-54m-medicare-fraud-scheme https://www.justice.gov/archives/opa/pr/doctor-sentenced-54m.... If you convince a confused elderly person that they need some device, and submit paperwork falsely certifying you agree they need it, that's not trivial to detect.
- tekno45 2y agoso how does the health insurance system stop this?
- SpicyLemonZest 2y agoThat’s what a claim denial is. If you dig into the details of a viral claim denial story of your choice, you’ll almost always find the same dispute: the insurance company thinks the doctor prescribed an expensive treatment when a simpler treatment would have worked just as well. I don’t mean to overstate the argument. Claim denials are a terrible way to resolve disputes like this, because they inflict quite a lot of pain and stress on the helpless patient who did nothing to cause it and can’t meaningfully help resolve it. But it’s important to understand why simply telling insurance companies to stop denying claims, despite its intuitive appeal, isn’t a real option.