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Insurance Fraud, Insurance Fraud Dictionary, Insurance Fraud Glossary,
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Results from search: http://www.i2.co.uk/applications/casestudies/forensic.html
Medical Insurance Fraud Case Study
Medical
Insurance Fraud
The following two cases are provided by Richard
Easton of the Forensic Intelligence Display & Analysis, Inc. The company provides
Litigation Support Services including profiles of individual suspects for Medical Case
Fraud and Forensic Case Review.
Dr Easton's examples show the uses of link and timeline charts to
present the information gathered in the investigation, in both civil or criminal cases.
Visual display of information is especially useful when a great deal of information has to
be presented clearly and understandably to non-technical or lay persons.
Case 1 - Prescription Drug Abuse
This case focussed on prescription
drug abuse. The original source data recorded the drugs prescribed by a set of doctors.
This information was imported into the Case Notebook and set against a timeline. This
quickly revealed that one patient was moving from one physician to another, obtaining
multiple prescriptions which would not have been prescribed by a single reputable
physician.
The complete set of charts make the systematic nature of this case
of drug abuse quite clear. This is an example of how the complex relationships of multiple
providers, multiple prescriptions and multiple pharmacies can be portrayed graphically to
clarify a series of otherwise confusing (planned) events.
Case 2 - Recurring Employee Injury
This case centered on an employee's recurrent "injury"
with associated work-loss time. Dr Easton and his colleagues identified a possible
explanation for this unfortunate medical problem when certain references to deer hunting
led them to compare the employee's records against a publication from the State Department
of Game and Inland Fisheries with the dates of all hunting seasons in the State.
The Annual deer (rifle) season occurs between November and
January. Working backwards from the "recovery" of the employee in January of
1998 to Nov '96-Jan '97 and then back to Nov '95-Jan '96, the reason for the recurrent
absences from work became clear. They coincided with the deer hunting season each year.
Graphic portrayal of the deer hunting seasons showed that they
coincided almost perfectly, on an annual basis, with the onset of complaints and the
"miraculous" recovery of the employee each year on approximately the same day in
January. This made disposition of this fraudulent claim a short, very successful exercise.
The local deer were also grateful!
Results from search: http://www.usps.com/websites/depart/inspect/insur.htm
Cut-Rate Health Insurance Fraud
United States Postal Inspection Service
Cut-rate Health Insurance Fraud
Senior citizens, perhaps more so than any other group of people in America, are aware of
the high cost of medical care. While Medicare does cover many bills, it does not pay for
everything. Seniors, who generally live on fixed incomes generated by Social Security,
interest, and small pensions, sometimes buy supplemental insurance to pay for medical
expenses not covered by Medicare.
There are sources for legitimate supplemental medical insurance. However, some policies
offered to seniors through mailed advertisements and in other ways are offered by
unscrupulous companies and salesmen who will try to sell anything they can, whether there
is a need for it or not. Such policies will provide inadequate or inappropriate coverage.
Don't be like one 93 year old woman who thought she was purchasing a valuable health
insurance policy, only to learn that she had bought maternity insurance .
Reduce your chances of falling victim to health insurance fraud by carefully reading any
sales promotion you may receive in the mail, including the "fine print" in the policy. Be
suspicious if a company requests that you pay your premiums in cash, pay a year's premium
in advance, pressures you to buy immediately because "it's your last chance," or requests
that you sign a blank insurance form.
Be cautious about companies that offer policies that will protect you and your loved
ones for "only pennies a day." Such low premiums will be effective only for a short time
(usually 30 days); thereafter, the premium will increase dramatically. You may also find
you have purchased a policy which does not include the kind of coverage you need. Be careful
if a company uses a name which suggests it is connected with the federal government, the
Medicare program, or a well-known company. Unscrupulous companies will choose titles,
business addresses, and stationary styles purposely to mislead you into thinking you are
purchasing something of value from the government or a respected private company.
If you have any doubts about a health insurance policy that someone is trying to sell
you, discuss the offer with a knowledgeable friend or relative or with an accountant,
attorney, or other trusted advisor. And remember to notify your local postmaster or the
nearest Postal Inspector about deceptive health insurance promotions received through the
mail so action can be taken to prevent other people from getting taken.
| Inspection Service
Home Page |
Results from search: http://www.metlife.com/Lifeadvice/Money/Docs/fraud6.html
Results from search: http://www.quackwatch.com/02ConsumerProtection/insfraud.html
Insurance Fraud and Abuse
Quackwatch Home Page
Insurance Fraud and Abuse:
A Very Serious Problem
Stephen Barrett, M.D.
Fraud and abuse are widespread and very costly to America's
health-care system. Fraud involves intentional deception or misrepresentation
intended to result in an unauthorized benefit. An example would
be billing for services that are not rendered. Abuse involves
charging for services that are not medically necessary, do not
conform to professionally recognized standards, or are unfairly
priced. An example would be performing a laboratory test on large
numbers of patients when only a few should have it. Abuse may
be similar to fraud except that it is not possible to establish
that the abusive acts were done with an intent to deceive the
insurer.
Although no precise dollar amount can be determined, some authorities
contend that insurance fraud constitutes a $100-billion-a-year
problem. The United States General
Accounting Office estimates that $1 out of every $7 spent
on Medicare is lost to fraud and abuse and that in 1998 alone,
Medicare lost nearly $12 billion to fraudulent or unnecessary
claims [1].
Type of Fraud and Abuse
False claim schemes are the most common type of health insurance
fraud. The goal in these schemes is to obtain undeserved payment
for a claim or series of claims [2]. Such schemes include any
of the following when done deliberately for financial gain:
Billing for services, procedures, and/or supplies that were
not provided.
Misrepresentation of what was provided; when it was provided;
the condition or diagnosis; the charges involved; and/or the
identity of the provider recipient.
Providing unnecessary services or ordering unnecessary tests
[3].
Many insurance policies cover a percentage of the physician's
"usual" fee. Some physicians charge insured patients
more than uninsured ones but represent to the insurance companies
that the higher fee is the usual one. This practice is illegal.
It is also illegal to routinely excuse patients from copayments
and deductibles. (A copayment is a fixed dollar amount paid whenever
an insured person receives specified health-care services. A deductible
is the amount that must be paid before the insurance company starts
paying.) It is legal to waive a fee for people with a genuine
financial hardship, but it is not legal to provide completely
free care or discounts to all patients or to collect only from
those who have insurance. Studies have shown that if patients
are required to pay for even a small portion of their care they
will be better consumers and select items or services because
they are medically needed rather than because they are free. Routine
waivers thus raise overall health costs. They are considered fraudulent
because averaging them with the doctor's full fees would make
the "usual" fees lower than the amounts actually billed
for.
Other illegal procedures include:
Charging for a service that was not performed.
Unbundling of claims: Billing separately for procedures that
normally are covered by a single fee. An example would be a podiatrist
who operates on three toes and submits claims for three separate
operations.
Double billing: Charging more than once for the same service.
Upcoding: Charging for a more complex service than was performed.
This usually involves billing for longer or more complex office
visits (for example, charging for a comprehensive visit when
the patient was seen only briefly), but it also can involve charging
for a more complex procedure than was performed or for more expensive
equipment than was delivered. Medicare
documentation guidelines , issued in June 2000 describe what
the various levels of service should involve [4].
Miscoding: Using a code number that does not apply to the
procedure.
Kickbacks: Receiving payment or other benefit for making
a referral. Indirect kickbacks can involve overpayment for something
of value. For example, a supplier whose business depends on physician
referrals may pay excessive rent to physicians who own the premises
and refer patients. Another example would be a mobile testing
service that performs diagnostic tests in a doctor's office.
Kickbacks can distort medical decision-making, cause overutilization,
increase costs, and result in unfair competition by freezing
out competitors who are unwilling to pay kickbacks. They can
also adversely affect the quality of patient care by encouraging
physicians to order services or recommend supplies based on profit
rather than the patients' best medical interests. The Office
of the Inspector General recently issued a fraud
alert warning against kickbacks disguised as rental payments
[5].
Criminals sometimes obtain Medicare numbers for fraudulent
billing by conducting a health survey, offering a free "health
screening" test, paying beneficiaries for their number, obtaining
beneficiary lists from nursing homes or boarding facilities, or
offering "free" services, food, or supplies to beneficiaries.
Excessive or Inappropriate Testing
Many standard tests can be useful in some situations but not
in others. The key question in judging whether a diagnostic test
is necessary is whether the results will influence the management
of the patient. Billing for inappropriate tests -- both standard
and nonstandard -- appears to be much more common among chiropractors
and joint chiropractic/medical practices than among other health-care
providers. The commonly abused tests include:
Computerized inclinometry: Inclinometry is a procedure that
measures joint flexibility. Inclinometer testing may be useful
if precise range-of-motion measurements are needed for a disability
evaluation, but routine or repeated measurements "to gauge
a patient's progress" are not appropriate [6].
Nerve conduction studies: These tests can provide valuable
information about the status of nerve function in various degenerative
diseases and in some cases of injury [7]. However, "personal
injury mills" and often use them inappropriately "to
"follow the progress" of their patients.
Surface
electromyography : This test, which measures the electrical
activity of muscles, can be useful for analyzing certain types
of performance in the workplace. However, some chiropractors
claim that the test enables them to screen patients for "subluxations"
and to follow their progress. This usage is invalid [6].
Thermography: Thermographic devices portray small temperature
differences between sides of the body as images. Chiropractors
who use thermography typically claim that it can detect nerve
impingements or "nerve irritation" and is useful for
monitoring the effect of chiropractic adjustments on subluxations.
These uses are not appropriate [6].
Ultrasound
screening : Diagnostic ultrasound procedures have many legitimate
uses. However, ultrasonography is not appropriate for "diagnosing
muscle spasm or inflammation" or for following the progress
of patients treated for back pain [6].
Unnecessary x-rays: X-rays examinations can be important
to look for conditions that require medical referral. However,
it is not appropriate for chiropractors to routinely x-ray every
patient to look for "subluxations"
or to "measure the progress" of patients who undergo
spinal manipulation [6].
Spinal videofluoroscopy: This procedure produces and records
x-ray pictures of the spinal joints that show the extent to which
joint motion is restricted. For practical purposes, however,
simply physical examination procedures (such as asking the patient
to bend) provide enough information to guide the patient's treatment
[6].
Many insurance administrators are concerned about chiropractic
claims for "maintenance care" (periodic examination
and "spinal adjustment" of symptom-free patients) ,
which is not a covered service. To detect such care, many companies
automatically review claims for more than 12 visits. In 1999,
the U.S. Inspector General recommended automatic review after
no more than 12 visits for Medicare recipients [8]. Some chiropractors
attempt to avoid review by issuing a new diagnosis after the 12th
visit.
Personal Injury Mills
Many instances have been discovered in which corrupt attorneys
and health-care providers (usually chiropractors or chiropractic/medical
clinics) combine to bill insurance companies for nonexistent or
minor injuries. The typical scam includes "cappers"
or "runners" who are paid to recruit legitimate or fake
auto accident victims or worker's compensation claimants. Victims
are commonly told they need multiple visits. The providers fabricate
diagnoses and reports and commonly provide expensive but unnecessary
services. The lawyers then initiate negotiations on settlements
based upon these fraudulent or exaggerated medical claims. The
claimants may be unwitting victims or knowing participants who
receive payment for their involvement [9]. Mill activity can be
suspected when claims are submitted for many unrelated individuals
who receive similar treatment from a small number of providers.
Quackery-Related Miscoding
In processing claims, insurance companies rely mainly on diagnostic
and procedural codes recorded on the claim forms. Their computers
are programmed to detect services that are not covered. Most insurance
policies exclude nonstandard or experimental methods. To help
boost their income, many nonstandard practitioners misrepresent
what they do. They may also misrepresent their diagnosis. For
example:
Brief or intermediate-length visits may be coded as lengthy
or comprehensive visits.
Patients receiving chelation
therapy may be falsely diagnosed as suffering from lead poisoning;
and the chelation may be billed as "infusion therapy"
or simply an office visit [10].
The administration of quack cancer remedies may be billed
as "chemotherapy."
Live-cell
analysis may be billed as one or more tests for vitamin deficiency.
Nonstandard
allergy tests may be represented as standard ones.
Services not covered because they were performed outside
of the United States may be billed as though they were performed
within the United States.
Viatical Fraud
In a viatical settlement transactions, people with terminal
illnesses assign their life insurance policies to viatical settlement
companies in exchange for a percentage of the policy's face value
[11]. The company, in turn, may sell the policy to a third-party
investor. The company or the investor then becomes the beneficiary
to the policy, pays the premiums, and collects the face value
of the policy after the original policyholder dies. Fraud occurs
when agents recruit terminally ill people to apply for multiple
policies. They misrepresent the truth and answer "no"
to all of the medical questions. Healthy impostors then undergo
the medical evaluation. In many cases, the insurance agent who
issues the policy is a party to the scheme. The agent or one applicant
may even submit the same application to many insurance companies.
Viatical settlement companies then purchase the policies and sell
them to unsuspecting third-party investors. The insurance industry
is the biggest victim of this fraud and could incur huge losses
(conservatively estimated at $1 billion+) within the next few
years [12]. Some investors receive nothing in return for their
"guaranteed" investment.
Anti-Fraud Programs
Several large insurance companies have joined forces through
the National Health Care Anti-Fraud
Association to develop sophisticated computer systems to detect
suspicious billing patterns. The Federal
Bureau of Investigation (FBI) and the Office
of the Inspector General (OIG) each have assigned hundreds
of special agents to health-fraud projects. The Coalition
Against Insurance Fraud ,
a public advocacy and educational organization founded in 1993,
includes consumers as well as government agencies and insurers.
The Fraud Defense Network ,
founded in 1994, is an Internet-based alliance of insurance companies,
government agencies, and other interested parties working to prevent,
detect, and investigate fraudulent activity.
The Omnibus Consolidated Appropriation Act of 1997 authorized
a Health Care Anti-Fraud, Waste, and Abuse Community Volunteer
Demonstration Program to further reduce fraud and abuse in the
Medicare and Medicaid programs. The program enrolled thousands
of retired accountants, health professionals, investigators, teachers,
and other community volunteers to help Medicare beneficiaries
and others to detect and report fraud, waste, and abuse. The Health
Insurance Portability and Accountability Act of 1996 funded a
similar program that trained community agency workers [13]. This
act also gave the U.S. Inspector General jurisdiction over private
insurance plans as well as public ones.
The Inspector General's office has recovered over a billion
dollars through fines and settlements. Its Operation
Restore Trust , which began in 1995, is a joint federal-state
program aimed at fraud, waste, and abuse in three high-growth
areas of Medicare and Medicaid: home health agencies, nursing
homes, and durable medical equipment suppliers. The questionable
activities have included:
Billing for advanced life support services when basic life
support was provided. Documentation may be falsified to indicate
a patient needed oxygen -- which is a key indicator in establishing
medical necessity for advanced life support.
Billing for larger amounts of drugs than are dispensed; or
billing for brand-name drugs when less expensive generic versions
are dispensed.
Billing for more miles than traveled for transportation.
Falsification of documentation to substantiate the need for
a transport from a hospital back to the patient's home. Medicare
will only cover transport from hospital to home if the patient
could not go by any other means.
What You Can Do
Many frauds can be detected by examining insurance payment
reports to see whether they accurately reflect the services rendered.
Suspicious reports involving a private insurer claim should be
reported to the company's fraud department. Suspicious practices
involving Medicare or other federal programs should be reported
to the OIG
Hotline by phone (1-800-368-5779) or e-mail .
Recommended Publications
The Fraud Report
(Fraud Defense Network)
Fraud
Trends Update
Millin's Health Fraud Monitor
Other Information Sources
Aetna
US. Healthcare Coverage Policy Bulletins
American
Association of Retired Persons
Coalition
Against Insurance Fraud
Medicare
Fraud Prevention Tips
Department
of Justice Health Care Fraud Report (1997)
Department
of Justice Health Care Fraud Report (1998)
Health
Insurers' Anti-Fraud Programs Research Findings (1999)
Medicare
Coverage Issues Manual (lists many noncovered products and
procedures)
OIG
Office of Evaluations and Inspections
OIG
Semi-Annual Reports
Other
Fraud Links
References
Department
of Justice Health Care Fraud Report, Fiscal Year 1998 . Washington,
DC: Department of Justice, 1999.
BlueCross & BlueShield United of Wisconsin. What
is health care fraud? Accessed Nov 30, 1999.
Guidelines
to health care fraud . Adopted by the National Health Care
Anti-Fraud Association Board of Governors, Nov 19, 1991.
Draft
evaluation and management guidelines , Health Care Financing
Administration, June 2000. [PDF}
Rental
of space in physician offices by persons or entities to which
physicians refer . OIG Special Fraud Alert, February 2000.
Homola S. Inside
Chiropractic: A Patient's Guide . Amherst, NY: Prometheus
Books, 1999.
Campbell WW and others. Recommended
policy for electrodiagnostic medicine . American Association
of Electrodiagnostic Medicine, Sept 26, 1996.
Brown JG. Utilization
parameters for chiropractic treatments . Washington, DC: Office
of the Inspector General, Nov 1999. [ PDF
document ]
Stern RA, Montana R. Identify patterns of medical provider
fraud through data base graphic pattern. FDN Fraud Report, Nov
1999.
Barrett S. Chelation
therapy and insurance fraud . Quackwatch, May 8, 2000.
Viatical settlements . FTC, 1998.
Kohtz DA. Viatical fraud .
Quackwatch, Aug 16, 2000.
Implementation
of the Administration on Aging's health care fraud and abuse
programs: 18-month outcomes . Washington, DC: Office of Evaluations
and Inspections, Aug 1999.
Insurance
Fraud Case Reports on Chirobase
Quackwatch Home Page
This article was revised on August
16, 2000.
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Should Managed
Care Companies Cover "Alternative Medicine"? (posted
1/24/99)
Views of a
Concerned Layperson (posted 8/23/01)
White House
Commission on Complementary and Alternative Medicine Policy
(posted 3/4/02) NEW FEATURE
Detailed Analysis
of WHCCAMP Draft Report (updated 3/4/02) NEW FEATURE
A Skeptical Look (index
to Dr. Barrett's weekly column on Canoe.ca)
Books: Recommended and Nonrecommended (to be posted)
Journals and Newsletters: Recommended and Nonrecommended
(to be posted)
"Anti-Aging"
Programs (posted 7/23/01)
Arthritis: Questionable Approaches (to be posted)
Aromatherapy:
Making Dollars out of Scents (updated 8/22/01)
Ayurvedic Mumbo-Jumbo
(updated 11/3/98)
Cancer: Questionable
Therapies (index to many articles, updated 12/12/01) FEATURE TOPIC
"Calorie-Blockers" (posted 7/5/01)
"Candidiasis
Hypersensitivity/Yeast Allergy" (updated 9/19/01)
"Cellulite"
Removers (updated 8/10/00)
Chelation
Therapy (updat ed 9/14/00) FEATURE
Chinese Medicine
(updated 7/30/99)
Chiropractic:
FEATURE TOPIC - ALSO
VISIT CHIROBASE
Don't Be Fooled
(updated 7/31/98)
Chiropractic's
Dirty Secret: Neck Manipulation and Strokes (posted 2/5/02)
NEW
Advertising
Gimmicks (posted 5/20/97)
Steer Clear
of Chiropractic Nutrition (posted 5/17/97)
Pediatrics (to be posted)
Subluxations:
Chiropractic's Elusive Buzzword (updated
12/25/01)
Undercover
Investigations (posted 9/14/97)
How Chiropractors
Oversell Themselves (updated 11/20/98)
My Visit
to a "Straight" Chiropractor
(updated 9/11/98)
Inside View
of a Chiropractic Office (posted 7/14/97)
Applied Kinesiology (updated 4/23/99)
Contact
Reflex Analysis (updated 4/16/98)
What
a Rational Chiropractor Can Do for You
(link to Chirobase)
Does the
Bad Outweigh the Good? (posted 3/23/01)
"Veterinary
Chiropractic" (link to Chirobase)
Chiropractic
Victim Support Group (posted 6/13/98)
Colloidal
Minerals (posted 12/11/98)
Colloidal
Silver (updated 12/2000)
Colon Therapy
and Related Quackery (updated 8/11/99)
Craniosacral
Therapy (updated 8/21/01)
Dentistry: Dubious Care
Holistic
Dentistry (revised 8/4/01)
Mercury-Amalgam
Scam (updated 4/23/02)
Neuralgia
Inducing Cavitational Osteonecrosis (NICO)
(updated 7/14/00)
"Detoxification"
Schemes (posted 8/15/97)
DHEA: Ignore
the Hype (updated 10/12/98)
Dietary
Supplements, Herbs, and Hormones (index
to many articles, updated 7/23/01) FEATURE TOPIC
Dubious
Diagnostic Tests (index to many articles,
updated 12/5/01) FEATURE
TOPIC
Ear Candling (updated 8/16/01)
Electrodiagnostic
Device Quackery (slow-loading article,
updated 1/15/02) FEATURE
"Ergogenic
Aids" (updated 8/14/00)
Eye-Related
Quackery (updated 3/5/01)
Fad Diagnoses (index to 13 articles, updated 12/12/01) FEATURE TOPIC
Fad Diets (to be posted)
Faith Healing (updated 12/17/01)
Glucosamine
for Arthritis (updated 1/23/02) MAJOR UPDATE
Gamma-hydroxybutyric
Acid: A Growing Danger (posted 7/17/98)
Hair Analysis:
A Cardinal Sign of Quackery (updated
1/5/01)
Hair
Removal Methods: What Works and What Doesn't (u pdated
8/21/01)
Herbal Practices and Products
The Herbal Minefield (updated 7/22/00)
Paraherbalism:
Ten False Tenets (posted 8/31/99)
"Natural
Product" of the Month: DMAE NEW FEATURE
Homeopathy ALSO VISIT HOMEOWATCH
The Ultimate
Fake (updated 8/25/01) FEATURE
Essay by Oliver
Wendell Holmes (1842) (posted 3/26/99)
Hyperbaric
Medicine: What Works and What Does Not? (partially posted
4/21/01)
Insurance Fraud
and Abuse (updated 7/14/00)
Iridology (updated 7/23/01)
Juice
Plus+ ® (link to MLM
Watch)
Juicing (updated 9/7/99)
Low-Carbohydrate
Diets (including Atkins Diet) (posted
4/28/01)
Lyme Disease:
Questionable Diagnosis and Treatment
(updated 3/10/02)
Macrobiotics
(posted 9/27/01)
Mail-Order
Quackery (updated 7/11/01)
Magnet Therapy (updated 2/6/01)
Massage Therapy:
Riddled with Quackery (revised 5/11/02)
NEW
Mental Help, Questionable Approaches
Feingold
Diet (updated 3/11/02)
Nutritional Supplements
for Down Syndrome (updated 10/18/98)
Orthomolecular
Therapy (updated 7/12/00)
Procedures
to Avoid (updated 7/6/01)
Psychomotor
Patterning (posted 7/6/01)
Psychotherapy
Mismanagement (updated 9/4/01)
Self-Help
Products (updated 8/5/98)
Index to Mental
Help Topics (poste d 12/4/01)
Metabolic
Therapy (posted 7/1/01)
Multiple Chemical
Sensitivity (updated 9/8/00)
Multiple Sclerosis
"Cures" (updated 6/20/00)
Multilevel Marketing:
Mostly a Mirage (updated 8/167/01)
ALSO
VISIT MLM WATCH
Naturopathy
A
Close Look (updated 4/11/02)
Opposition
to Immunization (posted 12/29/01)
HEW
Report (1968) (updated 8/30/99)
Medicare
Testimony (1970) (posted 5/25/99)
Index
to more information (posted 1/8/02)
Nutrition
Insurance: A Skeptical View (posted 12/1201)
Organic Foods:
Will Certification Protect Consumers?
(updated 12/21/00)
Osteopathy's
Dubious Aspects (updated 4/24/01)
Pharmacists
Selling Dubious
Products and Services (updated 3/12/01)
Misuse
of Compounding (updated 12/5/99)
Pneumatic Trabeculoplasty
(PNT) for Glaucoma (updated 6/5/01)
Power Lines and
Cancer: Nothing to Fear (updated 5/17/01)
Qigong (updated 7/30/99)
Reflexology:
A Close Look (2/26/02) NEW
Therapeutic Touch (several articles, updated 1/4/00) FEATURE
Top Health
Frauds (FDA list, updated 4/5/99)
Unnecessary
Surgery (posted 2/22/99)
Vitamin C:
The Dark Side of Linus Pauling's Legacy
(updated 5/5/01)
Water-Related
Frauds and Quackery (index to several
articles, posted 12/2/01)
Weight
Control Gimmicks and Fraud s (updated 2/7/99)
Wild Yam Cream
Threatens Women's Health (updated 1/28/01)
Questionable Advertisements
"80%
of Doctors Take Antioxidants"
(updated 12/6/97)
"Bust Developers" (to be
posted)
Can
Florsheim Shoes Cure Your Magnetic Deficiency?
(updated 8/8/00)
"Chiropractic
Healing Successfully Treats Cancer"
(link to Chirobase)
Clarified
Butter (Ghee): Is It a health food ?
(updated 9/1/98)
Eckerd Drugs' "Personalized
Vitamins" (posted 7/4/01)
"Enzyme
Deficiency" (updated 8/31/01)
Gero
Vita, A. Glenn Braswell, and the 'Journal' of Longevity (u pdated 9/5/01) FEATURE
Homeopathic
Hype (posted 2/15/98)
Life
Force Energy Discs (posted 10/25/97)
Magnetic
Bracelet (posted 8/13/99)
Magnetize
Your Beverages? (posted 9/19/98)
"Mommy
My Ears Hurt" (posted 6/3/97)
"Oxygenated
Water" Device (revised 3/11/02)
Phytopharma/Plant
Macerat Weight-Loss Plan (updated 9/14/01)
"Recommend
Centrum to Bridge Nutrition Gaps"
(updated 8/9/98)
Phony Diet Pills (to be posted)
RecoveryT: An "Amazing" Story (posted 11/30/01)
Reflexology
Steering Wheel Cover (posted 9/16/97)
Slim
Slippers: A Precautionary Tale (posted 2/28/02) NEW
"Free
Preliminary Spinal Examination"
(posted 10/11/97)
Stress Vitamins (to be posted)
Tobacco Ads: What Is Their Message?
(to be posted)
Nonrecommended
Sources of Health Advice
Books (updated 8/20/01)
Credentials to Be Wary of (to be posted)
Degree Mills (updated 6/2/00)
Health-Food-Store
Advice: Don't Trust It! (updated 3/21/01)
Individuals
Robert Atkins, MD (to be posted)
Herbert Benson, MD (to be posted)
Jeffrey Bland, PhD (updated 9/2/99)
Patrick T. "Tim" Bolen
(updated 4/5/02) MAJOR UPDATE
Hulda
Clark's Bizarre Claims (updated 8/25/01)
Adelle Davis (posted 3/27/99)
Lorraine
Day, MD (updated 3/24/02) NEW
Kurt W. Donsbach (updated 11/3/00)
James S. Gordon, MD (posted 2/14/02) NEW
Earl
Mindell (link to another site)
Gary Null (updated 5/19/99)
David W. Rowland
(updated 5/6/00)
Bernie
Siegel, MD. (updated 11/25/98)
Lendon Smith,
M.D updated 12/22/01)
Andrew Weil, MD
(posted 3/10/02 )
Julian
Whitaker, MD (link to another site)
Other Individuals (Index)
(updated 4/16/02)
Questionable
Organizations: An Overview (updated
4/17/02)
American
Association of Nutritional Consultants
(updated 1/15/02)
Center for Medical Consumers (to be
posted)
Citizens for Health (to be posted)
Council for Responsible Nutrition (to
be posted)
Foundation for the
Advancement of Innovative Medicine
(revised 9/21/99)
National
Health Federation (link to another
site)
People's Medical
Society (updated 1/1/01)
Physicians Committee for Responsible
Medicine (to be posted)
Periodicals (updated 9/27/01)
"Psychic"
Advice by Mail or Telephone (updated
8/2/01)
Publishers That Promote Quackery
Avery Publishing Group (to be posted)
Future Medicine Publishing (to be posted)
Keats Publishing (to be posted)
Mary Ann Liebert, Inc. (to be posted)
Rodale Press (to be posted)
Nonrecommended
Web Sites (updated 2/21/01)
Consumer
Protection
Intelligent Consumer
Behavior (posted 5/1/97)
Doctor-Patient
Communication Tips (posted 5/3/97)
Antiquackery
Organizations (updated 11/13/01)
Where to Complain
or Seek Help (updated 10/15/00)
NCAHF Victim
Redress Task Force (updated 9/4/99)
Online Scams:
A Message from the FTC (posted 5/20/97)
Plaintiffs Wanted
for Consumer Protection Suits! (posted
9/19/99) FEATURE
Spam Messages
Some Strategies
to Prevent Spams (updated 6/14/01)
FTC Names "Dirty
Dozen" Spam Scams (posted 4/6/00)
Strengths and Weaknesses
of Our Laws (updated 9/15/01)
How Congress Weakened
the FDA in 1994 (updated 6/8/00)
Genetically Engineered
Foods Should NOT Bear Special Labels (posted 1/2/00)
Why Nutritionist
Licensing Is Important (updated 4/17/02)
AMA Discourages
Product Sales in Medical Offices (updated
11/23/99)
Viatical Settlements (posted 8/16/00)
The Assault on Consumer Protection
Standards (to be posted)
FDA Warning Letters
( 2001 )
Other Important Regulatory Actions
Enzymatic
Therapy (posted 8/15/00)
General Nutrition (updated 9/24/99)
Home Shopping Network (posted 4/17/99)
Consumer
Strategy: Health Promotion
Antioxidants
and other Phytochemicals: Current Scientific Perspective (updated 8/14/01)
Cancer Prevention: Real and Imaginary
Risk Factors (to be posted)
Cardiovascular Disease
Risk Factors (updated 12/20/00)
Cholesterol Control (to be posted)
Homocysteine:
A Risk Factor Worth Considering (updated
7/13/00)
Child Care Guides:
Infancy through Age 2 (eight articles,
posted 3/18/00)
Dietary Guidelines for
Americans (posted 2/12/97)
Dietary Guidelines for
Infants (updated 5/26/99)
Dietary Reference
Intakes: New Guidelines for Calcium and Related Nutrients (posted 11/23/97)
Dietary Supplements:
Appropriate Use (updated 5/11/01)
Exercise
Choosing and Using
Equipment (posted 11/7/97)
Guidelines (to be posted)
Fluoridation: Don't
Let the Poisonmongers Scare You! (4
articles, updated 3/4/01)
Food
Irradiation: A Valuable Public Health Measure
(link to another site)
Hormone-Replacement
Therapy (updated 1/28/01)
Immunization:
Common Misconceptions (updated 4/20/02)
Low-Fat Eating: Practical
Tips (3/31/00)
Osteoporosis Prevention (to be posted)
Sugar: Myths vs. Facts (to be posted)
Tobacco-Related
News (updated 4/7/00)
Vegetarianism:
Healthful But Not Necessary (updated
3/17/00)
Weight-Control Guidelines (to be posted)
Consumer
Strategy: Tips for Provider Selection
Choosing Physicians (to be posted)
Choosing
a Dentist (posted 1/31/01)
Where to Get
Mental Help (posted 5/28/01)
Where to
Get Nutrition Advice updated 7/4/00)
Choosing an Osteopathic
Physician (updated 4/24/01)
Choosing a Pharmacist (to be posted)
Choosing
a Chiropractor (updated 10/13/00)
Be Wary
of "Free Foot Exam" Ads (updated
12/20/98)
Board Certification:
What Does It Mean? (updated 12/5/00)
How to Check
a Physician's Credentials (updated
1/6/01)
Choosing
a Health Club (link to another site)
Personal Emergensy
Response Systems (posted 4/20/02) NEW
Nonrecommended
treatment facilities (posted 4/13/02)
Consumer
Strategy: Disease Management
Drugs
Tips for Prudent
Use (posted 10/25/99)
Overuse of Antibiotics,
Blood-Pressure Drugs, and Heartburn Drugs
(posted 2/19/99)
Glaucoma
Patients: Don't Waste Money on Overpriced Eyedrops
(posted 5/1/00)
Fibromyalgia
Strategies (8 articles, updated 2/13/00)
FEATURE TOPIC
Irritable Bowel Syndrome (posted 6/7/00)
Latex Allergy Epidemic (updated 1/23/00)
Low Back Pain (updated 5/18/99)
Refractive Surgery (updated 4/24/99)
Scoliosis: A Sensible
Approach (posted 1/14/98)
Education
for Consumers and Health Professionals
Consumer Health Textbook
Updates (link to CH Sourcebook)
Consumer Health
Library: Recommended Reference Books
(posted 8/12/01)
Consumer Protection
Books (updated 9/23/00)
Handling Challenges
to Skepticism (posted 9/30/99)
HONcode Principles:
What Do They Signify? (updated 7/24/00)
Internet Guidebooks: Recommended and
Nonrecommended (to be posted)
Internet
Health Scares (posted 9/12/99)
Internet Search Strategies (posted 8/25/01)
Media Watch: Critiques of Recent Articles
and Broadcasts
Consumer Reports' Attack
on Pesticides Criticized (posted 4/30/99)
Why You Should
Ignore the Baby Bottle Scare (posted
6/17/99)
The Unfounded
Vaccination/Autism Scare (posted 10/6/99)
News Briefs (many topics, updated 12/18/01)
Questions and Answers (updated 9/2/01)
Quiz: What's Your Consumer
Health IQ? (posted 9/19/97)
Recommended
Magazines, Newsletters, and Journals
(updated 6/2/01)
Reliable Agencies
and Organizations : (updated 3/10/01)
Urban Legends,
Rumors, and Hoaxes (updated 3/3/02)
Web
Site Evaluations (updated 10/11/01)
Research
Projects (Volunteers Needed)
Alternative
Cancer Treatment Registry (posted 9/20/98)
Antifluoridation Quackery (posted 10/14/98)
Dubious Advertising
Link Patrol
(posted 5/18/98)
Multilevel Marketing
through the Internet (updated 3/9/00)
Publicly Held Companies that Market
Questionable Products (to be posted)
Quackery for
Pets (updated 11/14/97)
Questionable Methods
Project (updated 1/9/99)
Tips for Journalists (to be posted)
Legal and Political
Activities (How You Can Help)
Fighting
Quackery: Tips for Activists (revised 6/12/00)
Prosecuting Wrongdoers
in California (updated 11/16/00)
Qui Tam Suits against
Health Care Fraud (posted 8/23/00)
Why Psychologists
Should Not Be Licensed to Prescribe Psychiatric Drugs (posted
4/15/02) NEW
Recommended
Links
Alternative Medicine
Advisory Page (Pertinent articles and links to scientific
abstracts)
American Council on Science
and Health (ACSH)
Chirobase (Quackwatch's
skeptical guide to chiropractic history, theories, and current
practices) FEATURE
Committee for the Scientific
Investigation of Claims of the Paranormal (CSICOP)
Health Care Reality Check
Health
Frontiers Center for Quackery Control
HomeoWatch (Quackwatch's
skeptical guide to homeopathy's history, theories, and current
practices) FEATURE
James Randi Educational Foundation
MLM Watch (Quackwatch's
guide to multilevel marketing) FEATURE
Museum of Questionable
Medical Devices
National Council Against
Health Fraud (NCAHF)
NutriWatch (Quackwatch's
guide to sensible nutrition) FEATURE
Qakatak
(Australian Skeptics)
The Quack-Files
RatbagsDotCom (fighting
quackery with humor)
Rational Rad
Skeptical Information
Sources (18 links, updated 8/7/01)
Skeptics Dictionary (over
400 topics)
Other Valuable Sites
(193 links, updated 514/02) FEATURE
Quackwatch abides by the
HONcode principles
of the
Health On the Net Foundation
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Ring , an alliance of sites that examine claims about paranormal
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Results from search: http://www.mdinsurance.state.md.us/jsp/consumer/Fraud.jsp10
MIA - Insurance Fraud
Insurance Fraud
What is Insurance Fraud?
Insurance fraud artists steal billions of dollars each year from hardworking Americans. According to the National Insurance Crime Bureau , it is estimated that each household pays approximately $300 extra in insurance premiums each year to offset the cost of insurance fraud.
Insurance fraud scams vary and more and more scams are created each year. Here are just a few examples of insurance fraud schemes:
Arson-for-profit: An owner, or someone hired by an owner, deliberately burns a business, home or vehicle to collect insurance money.
Disaster fraud: Unscrupulous operators persuade disaster victims (i.e. hurricane, fire, flood, etc.) to claim more damages than actually occurred, or they collect money to repair damaged property but never complete the work.
Exaggerated claims: The most common perpetrators of fraud are those who overstate their insurance claims to make up for the deductible.
Falsifying theft reports: A property owner reports items stolen or exaggerates the value of items taken in a burglary to collect insurance money.
Medical fraud: Unethical medical practitioners or providers work in concert with scheming patients to create fictitious accident-related injuries to collect on fraudulent disability, worker's compensation and personal injury claims.
Sliding: An insurance agent sells an unsuspecting consumer much more coverage than is needed.
Twisting: An insurance agent replaces a consumer's policy with a new, more expensive one without their permission and pockets the additional premium.
Vehicle scams: Vehicle schemes may include intentionally causing an accident to collect money; fabricating an accident to make false police and insurance reports; an auto body shop owner offering to 'hide' the deductible or inflate the extent of damage; vehicle owner intentionally destroys car to collect insurance; and, a vehicle owner uses another address or misrepresents other information to obtain a lower premium.
Worker's compensation fraud: An employee falsely claims a work-related injury or exaggerates the extent of a minor injury to collect worker's compensation benefits.
(Some information obtained from the National Insurance Crime Bureau website at www.nicb.com.)
Consumers are encouraged to report insurance fraud activities to the Maryland Insurance Administration's Insurance Fraud Division. You need not give your name. Simply call 1-800-846-4069.
Consumers may email their questions directly to the Maryland Insurance Administration. A representative will respond to your question or contact you for further information. Please include your:
Name
Email Address
Telephone Number
Address
Question
Click here to email us.
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Results from search: http://www.via-investigators.com/civildiv.htm
Vortex Child & Elder Care Abuse Investigators, Criminal & Civil
Investigation | New Jersey, New York, Pennsylvania
NJ Private
Investigators
CIVIL & CRIMINAL INVESTIGATION DIVISION
Broad Spectrum Civil & Criminal Investigations
including but not limited to:
Covert Investigations & Surveillance
Covert Video Surveillance
Insurance Fraud
Worker's Compensation
Accident Investigation
Wrongful Death
Assault, Rape, Sexual Assault And Harassment
Stalker Investigations
Child Abuse & Elder Care Abuse
Pretrial Investigative
Services
Missing Persons
Matrimonial
Employment Screening
Due Diligence
Asset Discovery
Home | About The Director | Civil
& Criminal Investigation Division
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| Forensic Medical Investigation | Contact
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Toll Free: 800-470-3541 | E-mail: justice@via-investigators.com
We investigate Insurance Fraud, Worker
Compensation, Accident, Wrongful Death, Assault, Rape, Sexual Harassment, Stalker, Child
and Elder Abuse.
New Jersey - New York - Pennsylvania
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Results from search: http://www.mrmib.ca.gov/MRMIB/MRMIP.html
MRMIP - TOC and Introduction
Introduction
Eligibility
Applicants Who Know They Are Currently Not Eligible
But
Expect To Be in the Future
Agents/Brokers, Employers and Applicants
Medi-Cal Beneficiaries
How the Program Works
Choosing a Health Plan
Benefits and Copayments
Pre-Existing Condition Exclusion Period for Blue
Cross
and Blue Shield PPO Subscribers
Post-Enrollment Waiting Period for Blue Shield
HMO,
Contra Costa Health Plan, Kaiser Permanente and Maxicare
How You May Waive All or Part of the
Exclusion/Waiting
Period
Dependent Coverage Information
Waiting List
Transfer of Enrollment
Disenrollment
Dispute Resolution/Appeals
Binding Arbitration
Coverage Brochures
Coordination of Benefits
Description of Plans and Benefit Highlights
Blue Cross of California
Blue Shield of California-
Access + HMO
Blue Shield of California-
Preferred Plan
Contra Costa Health
Plan
Kaiser Permanente Northern
California
Kaiser Permanente
Southern California
Subscriber Contribution by County Charts
Area 1 Rates
Area 2 Rates
Area 3 Rates
Area 4 Rates
Area 5 Rates
Area 6 Rates
Application
For more information call 1-800-289-6574
Introduction
The California Major Risk Medical Insurance Program (MRMIP) is an
innovative
MRMIP developed to provide health insurance for Californians who are
unable
to obtain coverage on the open market. The MRMIP is administered by a
five-member
Board who has established a comprehensive benefit package. Services in
the
MRMIP will be delivered through contracts with health insurance
providers.
Californians qualifying for the MRMIP will participate in the payment for
the cost of their coverage by paying premiums on their own behalf. The
MRMIP
will supplement those premiums to cover the cost of care. The MRMIP is
funded
by $40 million from tobacco tax funds.
Eligibility
Requirements
In order to be eligible for the Major Risk Medical Insurance Program:
You must be a resident of the state of California. A resident is a
person
who is present in California with intent to remain in California except
when absent for transitory or temporary purposes. However, a person
who
is absent from the state for a period greater than 180 consecutive
days
shall not be considered a resident.
You cannot be eligible for both Part A and Part B of Medicare, unless
eligible solely because of end-stage renal disease. (Being eligible for
one part or the other is acceptable.)
You cannot be eligible to purchase any health insurance for
continuation
of benefits under COBRA or CalCOBRA. (COBRA and CalCOBRA refers to
the federal law giving
people
under certain circumstances the right to continue coverage in an
employee
health plan for a limited time.) If you have COBRA or CalCOBRA you may
apply for
deferred
enrollment.
You must be unable to secure adequate coverage. This can be
demonstrated
in any of four ways:
If you have been denied individual coverage within the previous
12 months. A letter/copy of letter from a health insurance carrier
or health plan or health maintenance organization denying individual
coverage within the last 12 months must be submitted with your
completed
application.
If you have been involuntarily terminated for health insurance
coverage
within the previous 12 months for reasons other than nonpayment of
premium or fraud. A letter/copy of letter indicating involuntary
termination
from a health insurance carrier or health plan or health maintenance
organization or employer for reasons other than nonpayment of
premium
or fraud must be submitted with your completed application.
If you have been offered, in the previous 12 months, an individual,
not a group, health insurance premium in excess of the Major Risk
Medical Insurance Program subscriber rate for your first-choice
participating
health plan. A letter/copy of letter must be submitted with the
completed
application indicating that, within the last 12 months, you have been
offered by a health insurance carrier or health plan or health
maintenance
organization, a premium for the subscriber and/or their dependents
(when applicable) in excess of the MRMIP rate for the subscriber
and/or
their dependents.
If you are a member of a group of two or fewer (not including
dependents)
who has been denied health insurance coverage in the previous 12
months.
A letter/copy of letter indicating that a member of a group of two
or less has been denied by a health insurance carrier or health plan
or health maintenance organization for health insurance coverage
within
the last 12 months must be submitted with your completed
application.
Note: Letters from agents/brokers indicating that an individual is unable
to secure adequate private coverage will not be accepted as
documentation
for eligibility.
Applicants
Who Know
They Are Currently Not Eligible But Expect To Be in the
Future
If you are not currently eligible for the MRMIP, but anticipate becoming
eligible, you may also apply for this MRMIP. Examples of this are: if you
are currently enrolled in COBRA or CalCOBRA coverage or if your employer
has informed
you that you will be involuntarily terminated from insurance coverage
sometime
in the future.
To apply for a deferred enrollment, indicate when you will become
eligible
and include acceptable documentation. Acceptable documentation is a
letter
from a health insurance carrier or employer indicating when your
coverage
will end. The documentation must specify the exact date of termination
of
current coverage. Enrollment in temporary policies does not qualify for
deferred status.
If the MRMIP is not at maximum enrollment and all other eligibility
criteria are met, you will be enrolled in the MRMIP on the date that
eligibility
will occur. If the MRMIP is at maximum enrollment at the time you
become
eligible, your place on any waiting list is determined by the date on which
you originally applied, not the date that you became eligible for the
MRMIP.
Applicants for deferred enrollment must submit their initial
subscription
contribution with their application.
Payment will be refunded to you immediately if your deferred
effective
date is more than sixty (60) days from the date we receive your
application.
Agents/Brokers, Employers
and Applicants
Insurance Code Section 12725.5 states that it shall constitute unfair
competition
for an insurer, an insurance agent or broker, or administrator to refer an
individual employee, or their dependent(s) to apply to this MRMIP, for
the
purpose of separating that employee, or their dependent(s) from group
health
coverage provided in connection with the employee's employment.
Insurance Code Section 12725.5 further states that it shall
constitute
an unfair labor practice contrary to public policy for any employer to
refer
an individual employee, or their dependent(s) to this MRMIP, or to
arrange
for an individual employee, or their dependent(s) to apply to the
MRMIP,
for the purpose of separating that employee, or their dependent(s) from
group health coverage provided in connection with the employee's
employment.
Medi-Cal
Beneficiaries
While Medi-Cal beneficiaries are not prohibited from enrolling in the Major
Risk Medical Insurance Program, a Medi-Cal beneficiary should carefully
consider
the cost before signing up for our additional coverage. MRMIP subscribers
are responsible for their monthly subscriber contributions, a deductible
and/or
a copayment for services which could be up to $4,000 per year. Medi-
labels
cannot be used for MRMIP copayments.
How
the Program Works
Benefits
and Copayments
Subscriber may choose from any plan available to them as listed in the
enclosed
subscriber contribution by county charts. Description of
Plans
and Benefit Highlights and are also available by calling any MRMIP
health
plan at their toll-free number and asking for an Evidence of Coverage or
Certificate
of Insurance.
Subscribers will be responsible for their monthly subscriber
contribution
whether or not they receive a bill in that month. Subscribers may choose
from any plan available to them as listed in the Subscriber
Contribution by County Charts .
Health Maintenance Organizations (HMOs) in the MRMIP require a fixed
dollar
co-payment for some services and up to a 20% co-payment for other
services.
The Preferred Provider Organizations (PPOs) in the MRMIP may also
require
a fixed dollar co-payment for certain services and up to a 25% co-
payment
for other services. The out-of-pocket maximum per
calendar
year for all MRMIP plans is $2,500 for individuals and $4,000 for an
entire
household covered by the MRMIP. This maximum does not apply to
services
recieved by providers that do not participate in the subscriber's chosen
health plan's provider network, or to services not covered by MRMIP.
There
are MRMIP benefit limits of $75,000 per calendar year and $750,000 in a
lifetime.
Subscriber contribution amounts are updated on January first of each
year.
In addition, your subscriber contribution may change during the year if
your birthday moves you into a new age category. For married
subscribers
enrolled under two-party or family coverage, the age rating category will
be based on the age of the subscriber. Adjustments to subscriber
contributions
due to age changes will occur on the first of the month following the
birthdate.
Subscriber contributions may also change when
a member
moves from one area of the state to another. Adjustments to
subscriber contributions
will occur on the first of the month following notification of the move.
Each month you will receive a subscriber contribution notice from MRMIP.
Subscriber contributions are payable in advance and are due the first day
of every month. A subscriber contribution notice will be generated
monthly,
and will be sent out 30 days prior to the due date.
A delinquency billing or final notice will be sent out on the 15th day
following the paid to date.
There is a grace period of 31 days from the paid to date, and the
member's
coverage will remain in effect during this time.
Cancellation for nonpayment of subscriber contribution will take place
on the 32nd day following the paid to date. The cancellation will be
retroactive
to the paid to date, and a cancellation letter will be generated to the
subscriber.
A subscriber may pay either by check or money order. In addition, a
subscriber
may elect to have their monthly subscriber contribution automatically
deducted
from their checking account when accepted into the MRMIP.
Subscriber contribution checks that are returned to the subscriber's
bank
will result in disenrollment back to the last month(s) paid. The subscriber
may be reinstated upon request only if membership history indicates
that
cancellations of the same subscriber have not exceeded two instances in
a rolling 12 month period. The replacement check must include
subscriber
contributions to bring the account to current status with an additional
$25.00 NSF processing fee and must be received within the 31 day grace
period.
There is no application fee for applying to this MRMIP.
You
are required to submit your first month's subscriber contribution for
MRMIP
health care coverage, which is completely applied toward your first
month
of coverage if you are enrolled. Qualified insurance agents and brokers
may be paid a $50 fee by the state for explaining the MRMIP and
assisting
you in completing the application. The state does not require an individual
applying to this MRMIP to pay any fee, charge or commission to a
broker
or agent.
Pre-
Existing Condition
Exclusion Period for Blue Cross and Blue Shield PPO
Subscribers
For individuals who are enrolled in a participating health plan offering a
Preferred Provider Organization (PPO), there is a pre-existing condition
exclusion
period of 90 days. During this period, no benefits or services related to
a pre-existing condition shall be covered. Subscribers shall be required to
pay subscriber contributions during this period.
Results from search: http://www.lectlaw.com/files/cos59.htm
Cut-Rate Health Insurance Fraud
From the 'Lectric Law Library's stacks
Cut-Rate Health Insurance Fraud
Senior citizens, perhaps moreso than any other group of people in
America, are aware of the high cost of medical care. While
Medicare does cover many bills, it does not pay for everything.
Seniors, who generally live on fixed incomes generated by Social
Security, interest, and small pensions, sometimes buy supplemental
insurance to pay for medical expenses not covered by Medicare.
There are sources for legitimate supplemental medical insurance.
However, some policies offered to seniors through mailed
advertisements and in other ways are offered by unscrupulous
companies and salesmen who will try to sell anything they can,
whether there is a need for it or not. Such policies will provide
inadequate or inappropriate coverage. Don't be like one 93 year
old woman who thought she was purchasing a valuable health
insurance policy, only to learn that she had bought maternity
insurance.
Reduce your chances of falling victim to health insurance fraud by
carefully reading any sales promotion you may receive in the mail,
including the "fine print" in the policy. Be suspicious if a
company requests that you pay your premiums in cash, pay a year's
premium in advance, pressures you to buy immediately because "it's
your last chance," or requests that you sign a blank insurance
form.
Be cautious about companies that offer policies that will protect
you and your loved ones for "only pennies a day." Such low
premiums will be effective only for a short time (usually 30
days); thereafter, the premium will increase dramatically. You may
also find you have purchased a policy which does not include the
kind of coverage you need. Be careful if a company uses a name
which suggests it is connected with the federal government, the
Medicare program, or a well-known company. Unscrupulous companies
will choose titles, business addresses, and stationary styles
purposely to mislead you into thinking you are purchasing
something of value from the government or a respected private
company.
If you have any doubts about a health insurance policy that
someone is trying to sell you, discuss the offer with a
knowledgeable friend or relative or with an accountant, attorney,
or other trusted advisor. And remember to notify your local
postmaster or the nearest Postal Inspector about deceptive health
insurance promotions received through the mail so action can be
taken to prevent other people from getting taken.
-----
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