Having an eye for potential health insurance fraud is a skill that anyone can acquire and maintain through a deep knowledge of the insurance industry and their practices. Insurance coverage comes in many forms, and there are multiple ways to file a claim. Knowing the warning signs of a bad claim can save your company a great deal of money and headache.

If you are in a medical practice or office, you may have patients who are filing claims on their own. When this is the case, you want to be certain that they are filing their paperwork correctly. Otherwise, you could end up without a full payment for services you have rendered.

It is easy to spot these sorts of claims when they come back to you with larger amounts than were billed or addresses that you do not have on file for the patient. When the patient is trying to skim the insurance company, a medical practice ends up losing in a denied claim.

If you are underwriting and examining medical claims, there are other warning signs that will tip you off. Some are rather obvious but some are much more subtle.

If you find medical bills that are in perfect order by account number, that is next to impossible and the bills could be counterfeit. Also, most fraudulent claims will have the same name for the doctor, location and even the illness itself.

You may also find that claims are fraudulent when the address of the place of treatment and the address of the patient are the same.

You must use data that is available to the medical community to discover some cases of fraud. Health insurance fraud can be spotted when a patient has a higher-than-normal instance of visits to a physician or testing center. That patient might also have a higher-than-normal average cost per visit. Keeping the statistics at hand will make it easier to spot these bad claims.

Insurance coverage that is purchased in the short term also has a higher instance of fraudulent claims. This means that one must keep extra watch on short term policies.

You will also find that there are instances where there are no medical records available or an office refuses to release them. This could be a sign that the office or the patient is committing fraud. Also, these same fraudulent claims tend to have no x-rays, data, or post-operative notes available. The fraud becomes obvious when it seems as if the treatment never took place.

When learning to sniff out health insurance fraud, keeping step with all of the warning signs above will help to save your office or provider money over the long term.