Which of the following scenarios is the MOST ACCURATE example of insurer health care fraud?
A.
After negotiating discounts with its medical providers, the insurance company provides the negotiated rate to its consumers instead of the original amount.
B.
To obtain regulatory approval for increasing its rates, the insurance company submits inflated cost data for review.
C.
Upon identifying that a claimant has provided incomplete information, the insurance company refuses to pay a claim.
D.
While acting as an intermediary for a government health care program, the insurance company verifies provider claims before billing the government for them.
This is a clear example of insurer health care fraud, because the insurance company is intentionally submitting false information (inflated cost data) to regulators in order to gain financial advantage (e.g., justify rate increases).
This type of fraud involves deception for profit, which fits the definition of fraud.
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_denw
1 week ago