Protecting against healthcare fraud and maladministration
Healthcare fraud and the maladministration of claims increases premiums for our customers and we do our very best to eliminate it. There may only be a relatively small number of individuals or providers who engage in fraudulent activities, but innocent and careless overcharging for medical treatment also raises the cost of private medical insurance.
Fraud is the dishonest intent to obtain a financial gain from, or cause a financial loss to, a person or party through false representation, failing to disclose information or abuse of position.
Fraud is a crime.
Some examples of fraud under a medical insurance plan are:
- providing false or misleading information in order to obtain healthcare insurance or a reduction in premium;
- deliberately failing to disclose previous medical history when required
- claiming for treatments or services not received;
- using somebody else’s insurance to obtain treatments or services;
- altering invoices;
- claiming from more than one insurer for the same treatment or service; and falsifying diagnosis
Some examples of maladministration would include duplicate billing and incorrect billing for medical treatment and procedures.
How can you help us in our efforts to contain your costs?
There are some steps you can take to help protect yourself and keep costs down:
- compare medical bills with your records. Check the dates are correct and the treatments or services were actually provided to you;
- ask questions, if you do not understand or if there are any discrepancies;
- liaise closely with us in the event of a claim;
- contact us if you consider that your medical practitioner is providing treatment that is not necessary for you;
- carefully complete any claim forms. If there is anything you do not understand or are unsure of, please ask us;
- look after your insurance details and documentation;
- make sure you understand any documentation before you sign;
- keep copies of any documentation and correspondence sent; and
- report suspected fraud to us.
InterGlobal works closely with others to prevent fraud
We are committed to protecting you against fraud and also have statutory responsibilities to prevent our products from being used as a vehicle for financial crime. We operate strict controls to deter, prevent, detect and investigate fraud.
InterGlobal works with other insurance providers and the following organisations to prevent and detect fraud:
InterGlobal will share information with other organisations under S29(3) of the Data Protection Act with a view to:
- preventing fraudulent or improper claims;
- the prevention and detection of crime; and
- the apprehension and prosecution of offenders.
If You Suspect Fraud
If you suspect fraud or have any information relating to fraudulent activity, please contact our Investigations Team:
fraudgovernance@interglobalpmi.com
InterGlobal Investigations Team
Woolmead House East
The Woolmead
Farnham
Surrey
GU9 7TT
England
+44 (0) 1252 745 939
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