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"Cancelling a policy for fraudulent information withheld is more justifiable."
but you see the article and the news called those two things "mistakes or omissions " when really they were something else weren't they?
What is a can't win situation here is we do want someone to catch cheaters? In doing so, we get mad at them.
There are billions in healthcare costs going out to fraud every year. No matter who the payer is government or private player, somebody cheats.
The problem is who is the bad guy when somebody gets caught?
When your healthcare provider takes a bit of time to investgate a claim, you get a letter from your doctor or hospital, often citing collection if your bill isn't paid promptly. You yell at your HR who yells at the broker who yells at the carrier to speed up claims. In many cases it is just easier to raise rates than catch fraud, so many carriers do just that..
How does fraud occur? well done correctly nobody catches it. A phys theraphy company used to tack on a charge for the dixie cup of ice after treatment automatically... the dixie cup cost $7 each, if they actually gave you one. Submit a million claim forms with this $7 charge included in a $250 theraphy treatment and what did you make for a service you didn't provide?
Or you could be a nationally know medical school w/hospital and have a couple doctors double dip medicare..
We say we want the bad guys caught, but at the same time we get mad when they do.
I have no interests what so ever with healthnet and never heard of them till today, but wouldn't you think that a better example of mistakes and ommissions could be found? Than someone who lied about her weight and a heart condition? Couldn't they find someone who had bad handwritting or transposed a number? that's the best mistake they could find?
While I would like to get mad and shake my fist at the system, I am not going to do it for someone who was pulling a fast one of her own.
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