FRAUDELE ÎN SISTEMUL ASIGURĂRILOR MEDICALE – CONSECINȚELE ȘI METODELE DE COMBATERE A ACESTORA

Iulia CAPRIAN, Marcela ENACHE

Abstract


Pe parcursul unui an, există milioane de cereri de asigurări de sănătate depuse la companiile de asigurare, care ajută la prestarea serviciilor medicale mai accesibile. Un mic procent din aceste milioane de polițe de asigurare acordate sunt frauduloase, dar acest mic procent presupune un cost estimat la zeci de miliarde de dolari pe an, ceea ce conduce la prime mai mari și la alte cheltuieli suplimentare pentru consumatori. Dintre toate tipurile de fraudă existente în domeniul asigurărilor, frauda în domeniul asigurărilor medicale presupune furnizarea de informații false sau incomplete în cererile de asigurare, depuse pe baza unor circumstanțe înșelătoare, cu intenția de a obține anumite beneficii în baza contractului de asigurare. În acest caz, este foarte important ca societățile de asigurări să știe cum să gestioneze astfel de situații, iar  consumatorii să cunoască cum să se protejeze de fraude în domeniul asigurărilor.

 

MEDICAL INSURANCE FRAUDS – CONSEQUENCES AND METHODS OF FIGHTING AGAINST THEM

Over the course of a year, there are millions of health insurance claims submitted to the healthcare companies that help make quality care more affordable. Out of these millions of claims, a small percentage are fraudulent, but that small percentage supposes cost a estimated to a sum of tens of billions of dollars annually, leading to higher premiums and other out-of-pocket expenses. Out of all the types of insurance frauds, the medical insurance fraud makes up the majority of false claims, revealing why this is such an important problem. In this case, it is very important for companies to know how to manage these kind of situations and for consumers how to protect themselves.


Keywords


medical insurance, fraud, insurer, medical services, fraud management.

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References


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