Monday, August 8, 2011

Wellness Insurance Fraud: The Bane of Health Insurance Providers?

With the advent of therapeutic vacations, medical tourism and wellness holidays now payable by established health insurance providers, are these so-called outsourced medical procedures the new target of insurance fraud?

By: Ringo Bones

Recently, health insurance provider ERGO Insurance Group of Düsseldorf, Germany, experienced a rude awakening first hand on how it feels to be fleeced by some of their unscrupulous health insurance policy holders through wellness insurance fraud. During the past few years, a growing number of unscrupulous clients had been defrauding various health insurance providers by bogus medical tourism and wellness vacation bills and claims designed to enrich themselves and their complicit co-conspirators. Could this unscrupulous criminal enterprise over time eventually defraud health insurance providers out of business?

Most health insurance providers in Europe - not just in Germany - became a target of health insurance fraudsters due to their relative lack of due diligence procedures when it comes to processing policyholders' claims whether they are genuine or fraudulent. Phony doctors' bills / falsified documents propped up by local medical practitioners during the policyholders' wellness vacation and medical tourism procedures - which have recently been found out by the ERGO Insurance Group's ongoing investigation in Sri Lanka and other top medical tourism and wellness vacation spots around the world - are fast becoming de rigueur in recent health insurance fraud schemes. Even corrupt high-level local pfficials involved in the regulation of their own medical tourism industry are sometimes involved.

Sadly, 95% or more of the suspected cases of propped-up medical bills turned out to be bona fide cases of insurance fraud. Unfortunately, most court decisions involving health insurance fraud cases in the European Union tend to favor the suspected swindlers, making prosecution of health insurance fraud perpetrators very difficult on European soil. Could this make the wellness vacation insurance and medical tourism fraud cases the new bread-and-butter of local private investigation companies?

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