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Comment by gruez | Hacker News Reader

>If stuff like voluntary plastic surgery wasn't covered, what the hell kind of medical fraud would there be?

Off the top of my head: going to a doctor, conspiring with him to make an insurance claim that you had some sort of procedure done even though none was actually done, and splitting the claim check? Not saying this happens, but it's not hard to think of frauds you could perform even if "voluntary plastic surgery wasn't covered".

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Or there's things like doctors ordering dozens of tests to identify a particular cold virus even though it wouldn't change the treatment or patient outcome, and oh, it just so happens the doctor owns the lab. (A real example)

Or a doctor prescribing a monthly massage to a patient. Or approving a questionable disability claim. etc. etc.

Fraud finds a way to happen.

There's no reason for the doctor to involve any patients, other than to write their names down. These are fraud factories submitting thousands of templated claims per year.

>There's no reason for the doctor to involve any patients, other than to write their names down.

...until the patient looks at his health insurance account and notices a charge that he doesn't recognize, or the insurance company decides to do a random audit of a claim.

Right, it's true that insurance companies investigating and denying claims is a major constraint on claims fraud. That's why Medicare and Medicaid still deny a lot of claims (although not so many as UHC) despite being publicly run.

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