Google the words, “what is health insurance”. What you’ll get is a dictionary definition, an article from Wikipedia, a set of video content, and then an article from medicalnewstoday.com, then the millions of other search results.
They all tell the same story (in different variation); what health insurance is. Which is an insurance policy that covers the cost of an insured individual’s medical and surgical expenses?
According to this Wikipedia article, there are 3 types of insurance fraud, and health insurance fraud is the first. According to the Coalition Against Insurance Fraud, approximately $80 billion worth of fraudulent insurance claims is made every year in the United States. And healthcare fraud is estimated to cost Americans $54 billion annually.
How are healthcare frauds carried out?
Healthcare fraud is exactly as you have imagined it; false information is provided to a health insurance provider to make them pay for unmerited benefits, to either the insured person, the healthcare provider or a third party.
This is committed by the policyholder, or health service provider (doctors and health centers). The insurance companies are the victims of this.
An insured person can commit this fraud by allowing a third party uses his insurance information to enjoy health benefits. Another popular way is making the insurance company pay for benefits that were not covered in the insurance policy, through falsification of records.
Billing for services that were not rendered, inflating the price of services rendered, carrying out unnecessary procedures, and falsifying patients’ diagnosis; are ways healthcare providers can defraud insurance companies.
See how healthcare frauds play out
Dr. Carson charged his patient’s health insurance for both services he provided and others that were not rendered. He did this by falsifying his patient’s medical record to reflect office visits and treatments that never occurred.
Joe is the only one in his family with health insurance, but he lets his siblings and entire family use his insurance information to receive healthcare benefits.
Healthcare fraud carries grievous penalties if the accused is found guilty (jail time and fines), but this has not stopped insurance companies from being defrauded. Insurance providers are all-in; in the fight against insurance defrauders.
When considered closely, the absence of a single source of truth on patients’ health record is the reason insurance defrauders are smiling at home, and insurance companies counting their losses.
Since medical records are controlled by healthcare providers, they can easily falsify it
To pay for healthcare benefits covered, insurance companies need the appropriate medical records on policyholders from their network.
These medical records are the tools which healthcare providers use to defraud insurance companies; by falsifying the records as they will. Since these records are made and controlled by these health centers, this is easy.
The blockchain can save insurance companies
The blockchain is rapidly gaining applications in other industries than finance. Cura Network is harnessing the technology to benefit the healthcare industry.
We’re using the blockchain technology to build a global decentralized healthcare system that provides a single ‘folder’ from which patients’ health records can be stored and retrieved.
This places patient’s health records in control of everyone, rendering falsification of health records impossible. Insurance companies can obtain accurate patients’ health records from the system to aid accurate payment decisions.
A decentralized platform like Cura Network will provide a single source of truth on the medical records of patients. This will serve as the final and reliable source of truth on the health records and history of patients. Enabling the execution of appropriate insurance healthcare policies for patients. With this, they cannot be ripped off by unscrupulous citizens who falsify medical records.