April 18, 2011 Articles

Preserving Copayments and Deductibles to Contain Healthcare Costs

Courts are allowing providers to effectively defraud insurers by allowing them to shirk their obligation to collect copayments.

By Andrew O. Bunn and Wilson D. Antoine

Whenever a third party is called on to pay costs or benefits on behalf of another—for example, when the government pays for public benefits for a citizen or a private insurer pays for a loss incurred by its insured—there is an opportunity for fraud and collusion between the person providing the benefits and the recipient. Whether submitting fraudulent Medicare invoices for reimbursement or making false claims to a private automobile insurer for personal or property losses that did not actually occur, those who pay benefits and claims utilize mechanisms to ensure bona fide claims and minimize or eliminate increased costs caused by fraudulent submissions.

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