Topic: Fraud and Abuse Eleanor Stevens is a health insurance professional for a

Question

Topic: Fraud and Abuse
Eleanor Stevens is a health insurance professional for a medical clinic. Clara Bartlett, a patient of the clinic, comes in for a physical examination. After the examination, Mrs. Bartlett approaches Eleanor and says, “Hon, my insurance company doesn’t pay for doctors’ visits unless I am sick or something. Dr. Forrest says I’m perfectly healthy, so I’ll have to pay today’s charge out of my own pocket. I’m a little short on money this month – the high cost of utilities and all – you understand don’t you? I’m wondering if you could help me out just a little by fudging something on the claim so my insurance will pay for it.”

How might Eleanor handle this situation?

Explanation / Answer

Ans : Mr. Eleanor can handle this case by calmly explaining the lady about the existence of Fraud and abuse act which states that any person who knowingly and willfully breaks the law could be fined, imprisoned or both. The breaking of law involves using incorrect codes intentionally or fudging.

The Elensor can also explain to her that it is truly illegal and if she indulges herself in this she may end up paying more penalty than her hospital visit and can also be imprisoned.

Explanation about the law to her can ceratinly benefit to overcome this issue.

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