decisionhealth Newsletters, Part B News - 2010 Issue 8 (August)
4 steps to protect your practice from fake health plans
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Article Overview
This article explains how fake or unlicensed health plans can affect medical practices, why they have become more common, and what general precautions providers can take when coverage looks unfamiliar. It is aimed at physicians, billing staff, and practice managers who need to evaluate suspicious insurance information, verify legitimacy with state agencies, and understand broader fraud-reporting and patient-protection concerns.
Why This Topic Matters
Fraudulent coverage can create significant collection problems, delay payment, and expose patients to financial and identity-theft risks. Understanding the warning signs and the role of state insurance departments helps practices reduce exposure before claims are submitted.
Article Sections
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How fake health plans burn you
Describes the financial and administrative risks associated with treating patients covered by suspicious health plans. It also discusses the difficulty of collecting payment when coverage is not legitimate.
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Take these four steps to protect your practice
Outlines general ways practices can respond when coverage information seems unfamiliar or questionable. It includes verification, patient communication, and reporting considerations.
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Health reform fuels growth of phony payers
Reviews broader market and enforcement context behind the rise in fraudulent plans. It also discusses how some schemes present themselves and how enforcement agencies respond.
What You Will Learn
- Why suspicious health coverage can create billing and collection problems
- How practices can approach verification of unfamiliar insurance information
- Why state insurance departments are relevant to fraud concerns
- What broader trends have contributed to the growth of phony health plans
Who Should Read This
- Physicians
- Practice managers
- Billing staff
- Office administrators
- Insurance verification staff
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