Preview

Insurance Fraud

Powerful Essays
Open Document
Open Document
13628 Words
Grammar
Grammar
Plagiarism
Plagiarism
Writing
Writing
Score
Score
Insurance Fraud
CHAPTER - 1
INSURANCE
1.1 Introduction
In law and economics, insurance is a form of risk management primarily used to hedge against the risk of a contingent, uncertain loss. Insurance is defined as the equitable transfer of the risk of a loss, from one entity to another, in exchange for payment. An insurer is a company selling the insurance; an insured, or policyholder, is the person or entity buying the insurance policy. The insurance rate is a factor used to determine the amount to be charged for a certain amount of insurance coverage, called the premium. Risk management, the practice of appraising and controlling risk, has evolved as a discrete field of study and practice.
The transaction involves the insured assuming a guaranteed and known relatively small loss in the form of payment to the insurer in exchange for the insurer's promise to compensate (indemnify) the insured in the case of a financial (personal) loss. The insured receives a contract, called the insurance policy, which details the conditions and circumstances under which the insured will be financially compensated.

1.2 History of insurance
In some sense we can say that insurance appears simultaneously with the appearance of human society. We know of two types of economies in human societies: natural or non-monetary economies (using barter and trade with no centralized nor standardized set of financial instruments) and more modern monetary economies (with markets, currency, financial instruments and so on). The former is more primitive and the insurance in such economies entails agreements of mutual aid. If one family's house is destroyed the neighbors are committed to help rebuild. Granaries housed another primitive form of insurance to indemnify against famines. Often informal or formally intrinsic to local religious customs, this type of insurance has survived to the present day in some countries where modern money economy with its financial instruments is not widespread.
Turning to

You May Also Find These Documents Helpful

  • Satisfactory Essays

    The concept of insurance is based on spreading the risks; it does not necessarily mean the risk will happen but chances are that it might happen. The concept is on taking…

    • 316 Words
    • 2 Pages
    Satisfactory Essays
  • Best Essays

    Organizational structure and culture influence have a huge effect on the success or downfall of an organization. Many organizations have proper processes in place to prevent health care fraud and abuse. This paper reviews fraud and abuse and how organizational structure and governance, culture, and focus on social responsibility affect or influenced the described situation. This paper will also review resources and allocation to prevent this type situation in the future, and the ethical issues that may relate to the determination of the described solution. Additionally, this paper will provide recommendations for structure or culture changes necessary to prevent this situation in the future.…

    • 1402 Words
    • 6 Pages
    Best Essays
  • Good Essays

    Fraud

    • 1250 Words
    • 5 Pages

    The main suspects at this time are Ben Hill, Michelle Shelton, Candie Harris, Sam MacCarty, and Phil Ackers. The red flags in this case deal primarily with a lack in segregation of duties. These suspects all juggle multiple roles, some of which are not listed in their job description. Some of these suspects actively seek out additional responsibilities and place themselves in roles where they probably do not belong. Further rationalization for choosing these suspects is outlined below.…

    • 1250 Words
    • 5 Pages
    Good Essays
  • Satisfactory Essays

    Health Care Fraud can be very destructive, and has cost our country millions of dollars.With the FBI being the lead investigators of this type of destruction in our country as well as "having jurisdiction over both federal and private insurance programs." (Health Care Fraud Article). It is important for the public to be aware of what to look for when it comes to any type of fraudulent activity when dealing with one's health information, and what it is you need to do to protect yourself from being a victim of this type of fraud. If for any reason you feel like you are a victim of health care fraud then you should immediately get in contact with your health insurance company.…

    • 243 Words
    • 1 Page
    Satisfactory Essays
  • Powerful Essays

    Marketing In Canada

    • 482 Words
    • 2 Pages

    *Insurance - It is a risk management from one entity to another in exchange for payment.…

    • 482 Words
    • 2 Pages
    Powerful Essays
  • Better Essays

    Health Care Fraud

    • 1468 Words
    • 6 Pages

    Health care fraud is a current health care issue throughout the health care industry from hospitals to home care services. “The National Health Care Anti-Fraud Association (NHCAA) estimates that health care fraud accounts for at least three, but as much as ten percent of total health care expenditures”(Hubbell, 2006). Health care organizations that work with medicare and medicaid are at higher risk for being a target for health care fraud. Many organizations have abused the use of the money system with billing illegal charges to insurance companies to allow for themselves…

    • 1468 Words
    • 6 Pages
    Better Essays
  • Good Essays

    Health Care Fraud

    • 58 Words
    • 1 Page

    Around the world, every health care system is wrestling with uprising costs and uneven quality regardless of the hard work of well intentioned , proficient clinicians. Health care advisors and policy makers have attempted numerous incremental solutions confronting fraud, decreasing errors, implementing practice guidelines, making clients better “consumers,” applying electronic medical record but none have had much influence.…

    • 58 Words
    • 1 Page
    Good Essays
  • Powerful Essays

    Fraud

    • 3763 Words
    • 16 Pages

    company. This company did very well until 1998 when a merger deal collapsed. Scrushy hired…

    • 3763 Words
    • 16 Pages
    Powerful Essays
  • Good Essays

    Fraud

    • 650 Words
    • 3 Pages

    Before answering the questions “what are my responsibilities for billing on a procedure that was not performed but asked to do so anyway”, Let me explain a little on Medical Billing Fraud? It is an attempt to fraudulently obtain payments from insurance carriers. Fraud in medical billing cost tax payers and medical providers millions of dollars annually (all-things-medical-billing.com). In 1996, HIPPA established the Health Care Fraud and Abuse Control Program (HCFAC) to help combat medical billing and health care fraud (pg.41). Fraud is an act done with the knowledge that you are doing wrong. Fraud is the intentional deception and misrepresentation that is to result in an unauthorized benefit. Abuse is the charging of services that are not medically necessary. False claim schemes are the most common type of health insurance fraud. The reasoning to do fraud is to obtain undeserved payments for claims. Some schemes to watch out for are: Billing for services, procedures and/or supplies that were not used. Unbundling of claims, this is billing separately for procedures that are covered by a single fee. Double billing, this is charging more than once for the same service.Upcoding, this is charging for more complex services than was performed.…

    • 650 Words
    • 3 Pages
    Good Essays
  • Better Essays

    Healthcare Fraud

    • 1833 Words
    • 8 Pages

    Fraud is a serious crime that should concern all parties of the U.S. health care system and is a costly reality that the government cannot overlook. While not all fraud can be prevented, by learning about the many different types of fraud, patients can be educated on how to protect themselves from fraud. If we use government programs to inform the public that they can be targeted, the dollar amount for these cases for fraud can be reduced. An informed public and a properly funded FBI will go a long ways in the overall crackdown of health care fraud.…

    • 1833 Words
    • 8 Pages
    Better Essays
  • Good Essays

    Fraud

    • 1450 Words
    • 6 Pages

    The rule that requires financial statements to reflect the assumption that the business will continue operating instead of being closed or sold, unless evidence shows that it will not continue.…

    • 1450 Words
    • 6 Pages
    Good Essays
  • Good Essays

    The need for insurance regulation arose in England from the collapse of large insurance companies in 1870 that required the financial assistance of the state. Similarly, in the Commonwealth Caribbean, lack of or poor regulation has seen fluctuation in rates, liquidity and insolvency crises, and even bankruptcies of insurance companies that required government intervention. This had caused loss of state funds, severe effects on policyholders, and financial instability in states such as Jamaica, Barbados, the Bahamas, and Trinidad and Tobago in the mid-1990s, that affected the Gross Domestic Product (GDP), increased public sector debt, and slowed economic growth. As such, insurance regulation has necessitated the legal framework of insurance (and regulation) legislation, to fill in the gaps that arise from the Common Law and to formally establish the stance of the legal system on insurance issues. (Fordyce v. American Life Insurance and Transport and Harbours Department, 1970)…

    • 723 Words
    • 3 Pages
    Good Essays
  • Powerful Essays

    Healthcare Fraud

    • 1998 Words
    • 8 Pages

    In the United States there are many different types of coverages available for individuals and hospital plans needing insurance coverage. While this can be of great assistance for those suffering from different injuries and ailments, it can also give birth to a vast number of methods to commit torts against the Government, Insurance companies, Health care providers and of course the individual tax payer.…

    • 1998 Words
    • 8 Pages
    Powerful Essays
  • Powerful Essays

    The aim of insurance is to shift risk from one person (the insured) to another (the insurers). In insurance contract as a matter of public policy, certain insurable requirements must be met, to make it valid. Insurable interest is one of the basic requirements of the insurance. Without it the insurance contract is a mere wagering agreement.…

    • 3246 Words
    • 13 Pages
    Powerful Essays
  • Best Essays

    * Kopf, E.W. (1929)’ Notes on the origin and development of reinsurance’ Papers in the…

    • 3279 Words
    • 14 Pages
    Best Essays

Related Topics