Translator
 |  |  |  |  |  |  |  |
 |  |  |  |  |  |  |  |
 |  |  |  |  |  |  |  |
 |  |  |  |  |  |  |  |
 |  |  |  |  |  |  |  |
 |  |  |  |  |  |  |  |
Is This Health Insurance Fraud?
Cassandra asked:
<BR%20/>Tags: Cassandra, Doctors Office, Fear, Twin Sister, Doe Point, Receptionist <BR%20/>ok, first of all I work for a doctors office as a receptionist. a while ago I was on myspace looking at one of my friend’s profile, and you know how one profile leads, to another, and so on. Well, I see one of my patient’s profile ‘jane doe” and i notice that she has a different name, then i realize that she has a twin sister but a fatter version claims to be “janice doe”
point is…i think my patient “jane doe” is using her obese twin sister;s (janice doe) insurance!!
what do i do? should i report my suspicions to the insurance company or my boss? but im also afraid that my boss might not care in fear of loosing money….i would
Yes, report it to your Boss. Print off the pages that made you suspicious and give that to your boss, then let your boss decide how to proceed.
get your doubts about Insurance program procedure solved here
Yes, that’s health insurance fraud.
You report the suspicions, to your state insurance commissioner’s fraud department.
Do you obtain photo identification (ex – copy of drivers license) from all patients? What about a social security number?
Your office has the right to verify identification and the name of every patient. And, of course, the patient should be signing the paperwork at your office. If “jane” is signing paperwork using “janice’s” name, then that’s a problem.
What is the name on the insurance card? What makes you think that “jane” is using “janice’s” insurance? Does the insurance card say “janice,” but the photo ID says “jane”? I’m trying to figure out what exactly is leading you to this conclusion.
If you’re really suspicious, there’s one thing you could do that wouldn’t get you in trouble necessarily. Just call the insurance company to verify benefits, and specifically point out that the identification you were presented shows a different first name. You’d have a valid reason for asking, because you’d want to be certain that the claims went out with the correct patient name.
Obviously “jane” and “janice” if twins would have the same date of birth, but they would still have different SSNs and drivers license numbers. These are things that can be checked. (Unless “jane” is presenting all of “janice’s” info.)
If they are doing what you think, then yes…they are committing insurance fraud. And if your office knows but ignores it, then they are complicit in the fraud.
Good luck!