Insurers providing private medical insurance cover have become an attractive target for fraudsters, both at an opportunistic level and at a pre-meditated and organised level. The threat of fraud in this sector is extremely diverse and derives not only from policy holders but also from health professionals and external suppliers.
Policyholder frauds may range from straightforward non disclosures and misrepresentations to submitting false documentation or participating in unnecessary treatment scams.
Provider fraud can comprise of the upcoding or unbundling of medical treatments but also extends to ghost patient scams and falsification of medical diagnosis / prognosis.
The fraud unit at Hill Dickinson has built up valuable experience in this niche area and can provide the technical know how, tactical awareness and quality of service to help effectively manage the fraud risk in your organisation. Our services in this area include:
- Defence litigation
- Recovery actions
- Policy interpretation
- Case investigations
- Asset tracing
- Search orders & Asset freezing
- Ombudsman submissions
