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Had an interesting thing happen in the last few weeks.
I received a letter from Bupa asking me to confirm or deny whether a particular woman was a genuine patient of mine.
It appears that a woman had made 2 Hicaps claims online for an F004 & an F014 under my name.
The woman has never been to see me.
The week I received the letter, the woman in question had attended two days prior with her husband for an Initial appointment for him.
Her claims however, had been made back in Sept, and as I mentioned, she was never a patient.
I faxed back this info to Bupa and asked them to contact me to explain how this could occur. She told me that as long as they know your name, your provider number comes up and they can just make a claim on the spot.
I find it remarkable that a person is able to make a claim online without having to send in a receipt for proof of attendance at a consult. Even medicare make you send in the receipts for online claiming.
The Bupa woman claimed they had various rules in place to catch people, but essentially this is a huge loophole for fraudulent people making false claims. How many slip through the net?
No wonder the health insurance premiums are so high when they're paying out all this money and have whole departments dedicated to tracking down fraud, when all they need to do is request proof with a receipt from the pod!

 

Our practice has had a couple of instances of similar fraud in the past.

The health insurer has contact us to confirm their attendance, and we either not seen them, or they have claimed for things such as foot orthoses that were never provided. Once, someone made up a bogus invoice with all of our particulars and submitted it for a refund.

Never underestimate the public! This seems like an extraordinary loophole though.

LL

 

I had a similar incident earlier in the year.
A patient had attended the clinic twice in 2009, but had claimed for regular treatment every month since then. The health fund were cagey with the exact details, but I should think a full colour scan of a reciept with a photoshop date change could easily create "evidence" of the treatment provided. Yet another reason to be very particular with record keeping. I also suggested we have either ourselves or our receptionists sign the receipts.

 

I can understand how some are getting away with dodgy claims if they are doctoring up their own receipts...but they shouldn't be able to make an online claim and have no receipt at all to show for it.

 

Nat, you're right - it's just asking for trouble isn't it?

 

Interesting that you have all been contacted..... wonder how they catch these guys????? wonder how many other 1000,s out there are doing it :-( Great income 4 them.......

On a side note... had a young man not yet in his teens in for Init Cons.. when I asked him/mum how they found us.. he was quick to know why I would want to know this? I advised that I thank all referrers and they go in the draw to win tickets... he was impressed,,, then took multiple biz cards advising he had lots of friends and was going to refer them--- then suggested he would set up a web site to refer people so he could maybe win more.....

there are so many very active minds out there :)

Thanks again for the thread Nat... keep well.

Cheers

Heather

 

Heather that is the best, l hope he wins something for his effort...a real entrepreneur in the making