DEAR EDITOR:

As a senior, and the recent victim of an unlawful integrated phantom overbilling scheme, followed by an unlawful balanced billing scheme, perpetrated by a local health care provider, it is imperative that individuals review their Explanation of Benefits (EOBs) received from their health insurance company before making any payment to their health care provider. Just because a health care provider sends a billing statement, it doesn’t necessarily mean that the amount is lawfully owed to the health care provider.

Health care fraud is a huge issue and consists of four principal schemes that include double billing, phantom billing, unbundling and upcoding.

With trillions of dollars in health care spending annually, fraud losses have been conservatively estimated at 3% of health care expenditures, but some law enforcement and government agencies estimate the loss as high as 10% of the total health care outlay.

While health care overbilling fraud has been a national issue for many, many years, it also contributes to increasing premiums and health care costs for everyone, from those covered by private insurance to Medicare beneficiaries including Medicare supplement policies.

So, please be sure to check those Explanation of Benefits, or EOBs, that your health insurance companies send out to fight back against health care provider overbilling fraud.

BRENT D. BERKMAN

CFE, CPA/CFF, Certified Fraud Examiner, Forensic Analyst, & Tax Expert Witness

Warren