Fraudulent Insurance Claims Also Driving Up Healthcare Cost- Whistle Blower Cash Incentives.

In view of the recent increase in mandatory co-payment for integrated healthcare (Shield) insurance plans, I thought I will do a short post to share some of the blatant abuse by "black sheep" policy holders which drives up the cost of "Hospitalisation and Surgical" ("H&S") Plans for the general public. The typical insurance claims abuse as follow:

1. Getting H&S Insurers to Pay For Health Screening

There are some policy holders who want to save money for health screening packages by claiming on their H&S plans. Some of you folks will be very puzzled at this juncture as you are right to think that H&S plans are only for hospitalisation and surgical procedures and does NOT cover health screening. 

The trick to game the system is to work with the medical specialists in private hospital. It is easy to fake a chest pain and then get the specialist to write a memo for hospital stay to do a myriad of medical tests in order for them to diagnose the root cause. The black sheep policy holder thus get a free health check up that runs into exorbitant thousands of dollars and is a blatant waste of money as a routine health checkup package is only S$500. Such black sheep will also boast about the lobster porridge and lobster lunch/dinner that comes with their medical stay at private hospitals. 

The worst part is that some of these black sheep actually go around telling colleagues/friends to not be stupid to spend their own money to do health screening and to use this ruse to defraud insurance companies and get free medical health screening and free seafood at private hospitals. They will also recommend their specialist doctors that are expert in crafting medical memo to twist and turn a health screening into a medical issue that qualifies for H&S claims. 

 

2. Using TCM Benefits on Personal Accident Plan To Get Free Tui Na Massage

Since we are already on the abuse topic to the H&S insurance, I will also deviate to another minor ruse that the black sheep folks pulled on Personal Accident ("PA") Plan. Nowadays, PA comes with TCM benefits for accidental injuries. 

Similar to the H&S ruse, the black sheep will work with certain TCM shops to issue an invoice and memo for treatment of accident injuries. However, in actual fact, this payment is being converted into a Tui Na Massage package for 5-10 sessions. 

Parting Thoughts and Whistle Blowing Rewards

I thought that such ruses by these black sheep are actually very selfish behaviour that drove up the cost of insurances for everyone. The insurance company should cater for a whistle blowing hotline for friends or colleagues to report such incidents and to give a 20% cash reward for money saved by insurer for every successful claw back case. Have you also encountered such black sheep around you?