Health insurers crack down on fraud

  • Breaking
  • 01/10/2014

By 3 News online staff

The private health insurance sector will be under closer scrutiny in the search for fraud with a new integrity register in force from today.

Fraud and undesirable billing practices within the sector is believed to cost $29 million in claims each year. But it is hoped the initiative will give a clearer idea of the size of the problem.

Members of the Health Funds Association (HFANZ) have agreed to create the register which will be maintained by PricewaterhouseCoopers.

The Association estimates up to 5 percent of all claims are bogus and end up costing $22 in premiums for each private health insurance member.

Under the new scheme, unusual billing practices will be sent to the register for cross-reference it to figure out a patter or extent of fraud.

HFANZ deputy chair and Accuro Health Insurance chief executive Geoff Annals says if there is clear evidence of fraud it will be referred to police and association members will also take their own actions against the supplier or customer.

"Sometimes members have been blind to practices in the past but collectively we can address it. It’s in the interests of our members that we stop this," Mr Annals says.

But Mr Annals says people shouldn't be afraid of the register.

"It’s about fairness, honesty and ensuring our members receive good value from their health insurance policies," Mr Annals says.

Examples of fraud include hospitals and doctors billing for services, procedures or supplies which are not provided, charging for normally free items or customers filing claims for services and medications they didn't receive.

The register will be able to flag suspicious activity such as when a patient claims for more than one heart bypass on the same day.

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source: newshub archive