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My Annual Allergist Visit Proved Health
Care Fraud Is Easy To Commit And Hard
To Report

Original Article

Posted By: mc squared, 6/28/2025 10:19:18 AM

Why do we have so much fraud in our health care system? Because the system’s incentives encourage it — and because authorities often don’t do enough to fight it. One of my recent experiences with the system reinforced those two simple and unsurprising lessons. I feel obligated to share the story of how I stumbled upon a possible Covid testing scam (with names and details omitted for legal purposes), to demonstrate how easy it remains for scammers to manipulate our health care system in ways that raise costs for all of us. Nonexistent Testing In the fall of 2022, I went for an annual allergy check-up.

Comments:

While I'm sure fraud has always been with us, covid made it easier and more profitable for providers.

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Reply 1 - Posted by: rikkitikki 6/28/2025 10:28:22 AM (No. 1970367)
While Covid testing was the cover for this fraud, the basic model of making fraudulent medical claims has been around as long as insurance companies have been offering medical coverage. The root of the problem is not the rules themselves, but the corruption intrinsic to the human race...as long as there are dishonest people, they will find ways to lie (or cheat, or steal) for their own benefit (in this case, to make fraudulent medical claims).
13 people like this.

Reply 2 - Posted by: chance_232 6/28/2025 10:53:49 AM (No. 1970385)
My other half reported an incident of fraud to the government several years ago. It went exactly nowhere. Here's the problem. If you report something. Someone might have to do their job and fill out another form. just easier for everyone to just ignore it. The government is far more cs oncerned with what it takes in. Not what it sends out. Case in point, USAID. If it doesn't help or hurt democrat politicians, they don't care.
8 people like this.

Reply 3 - Posted by: mean Gene 6/28/2025 10:54:07 AM (No. 1970386)
Insurers don't fully cover what doctors' offices bill. So, some office workers add in enough related stuff so that the insurance covers the full cost and saves the patient money out of pocket. I've also seen where a service cured the problem but the medical server tried to insist on more appointments so as to use up all the allotted coverage.
5 people like this.

Reply 4 - Posted by: mossley 6/28/2025 11:03:35 AM (No. 1970397)
Several years ago, I was getting some physical therapy after an accident. The PT place told me my insurance had approved an extra 10 days of treatments. The insurance hadn't. When I got the bill for the difference, they had charged for all kinds of services I never received. I reported it to the state AG office and BBB. The PT company dropped the bill, but the state didn't do squat.
8 people like this.

Reply 5 - Posted by: Kate318 6/28/2025 11:23:41 AM (No. 1970416)
All of the things that many of us were called conspiracy theorists for have come true. All of them.
9 people like this.

Reply 6 - Posted by: mc squared 6/28/2025 11:47:36 AM (No. 1970435)
#3: That's true. In order to be in a plan the provider agrees to a percentage of the billed amount. But the price is increased so that percentage is closer to the 'cash price' for the visit. I had to go out of network for a service and I was asked if it was insurance or self-pay. I was pleasantly surprised at my bill after seeing much higher rates charged to insurance companies.
4 people like this.

Reply 7 - Posted by: earlybird 6/28/2025 12:19:35 PM (No. 1970454)
There are other ways that predated Covid by decades. the coding for brief visit or detailed visit, for exampled, can make a big difference. $$$$ An endocrinologist I was seeing insisted I have an offidce visit to simply receive thyroid test results...something that can be given on the phone. Then he billed for a Detailed Visit although I was only with him for a few minutes.. I reported him to Medicare and my HMO. And found another doctor.
4 people like this.

Reply 8 - Posted by: anniebc 6/28/2025 2:40:52 PM (No. 1970501)
I know someone who has asthma and was prescribed about five medications. She was told she'd have to take the meds for the rest of her life. There are a lot of different concoctions for asthma based on certain factors, so she asked her doc to explain why she was given her five meds. Well, the doc told her it really depends on her insurance. At one time her doc had to go through hoops with the insurance company to up the dose (and cost) of one of her meds. If the doc said the increase was necessary, why would the insurance company give her doc a hard time approving it? Long story short, she was always a skeptic when it came to doctors and long term meds, but she no longer trusts taking the meds and only takes them when triggered. She's still fairly healthy and alive.
3 people like this.

Reply 9 - Posted by: Strike3 6/28/2025 6:44:48 PM (No. 1970566)
The COVID tests were free for the same reason that the COVID shots were free. Somebody was making a bundle of money due to special government consideration to what amounted to a simple variation of the flu and somebody had to provide that money. Big Pharma needed to be compensated for their R&D work so people were convinced that they could die. They COULD die but only if they took the shots.
5 people like this.

Reply 10 - Posted by: DogFacedPonySoldier 6/29/2025 4:08:52 AM (No. 1970677)
Anyone involved in health care knows it has become a federally funded money moving industry. Billing and procedure codes are created and owned (copyrighted) by the American Medical Association (a private corporation) and un-marketed tested reimbursement fees are attached to the procedure codes. Medicare CMS sets the fees. Insurance companies are given the privilege of paying less to the providers. The whole system is corrupt. Human sickness and age related physical decline are the greases that power the money moving system.
3 people like this.

Reply 11 - Posted by: New Mexico Rider 6/29/2025 8:58:40 AM (No. 1970731)
I recently received a Medicare notification about services that I'd never received from a company I've never heard of...claiming to be ordered by a doctor from my dim past. No charges were assigned to me but the fact that someone was submitting charges in my name bothered me. I called the Fraud Line number on the paperwork and it took quite a bit of explaining to the 'helpful' person on the line. Her assumption was that I was complaining about a charge to me...NO...I explained that the problem was the someone was submitting charges in my name for bogus services. The person on the Fraud Line couldn't understand the situation and had to go to her supervisor for instructions on how to handle this...FRAUD. Very strange.
0 people like this.

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