Here is a site that details systemic fraud by health insurance companies:
http://www.badfaithinsurance.org/
"Bad faith" insurance companies denial of unpaid claims are widespread, pervasive if not the norm, responsible for the greatest destruction and loss of U.S. and Americans wealth, assets, businesses, jobs and poverty, and ultimate maximum loss of human life. A 'legal' term, Bad Faith statutes and laws in each state are intentionally blindly overlooked and unenforced by states insurance regulatory agencies.
IT'S THE LAW: Insurance companies are required to 'willingly' pay claims properly and promptly in "Good Faith". It is illegal to 'willingly' not pay, discount-lowball, delay, deny payment of legitimate claims in "Bad Faith". When claims go unpaid in bad faith, the associated wealth-assets-loss of jobs-businesses are lost forever
Bad Faith insurance companies have had decades to rig the American and in some cases worldwide systems in their favor. Bad faith (BF) insurers non-payment of CLAIMS practices are proven pervasive and widespread. Upwards of 85-95%+ are proven bad faith (BF) insurers that repeatedly and consistently break the law. There is a traditional quiet covert revolving door between the insurance industry employees and state regulator employees which contributes to the status quo of claims resolutions by state regulators being 99.9% anti-claimants and pro-insurers
FBIC struggles to identify the Good Faith (GF) insurance companies from the small number remaining as the outrageous and overwhelming number of Americans consumer complaints submitted to states insurance regulators exceed an astounding one million plus annually. Let there be no doubt that it is the insurance industry with their unlimited legal, financial resources and power that regulate the states insurance regulators-authorities and not the other way around which is the correct and way its supposed to be. Besides the states tiny insurance regulator agencies resources in comparison that neither have 1% of the necessary resources nor indicate or show any interest in doing anything about the "degree" of breach of contracts and/or the bad faith insurance payment claims status quo that is perpetrated and exists amongst 92.7% of ALL insurers, and which relativity FBIC uses in its ranking determinations. This is why it is essential that the U.S. Government have oversight control over state insurance regulators regarding interstate common ownership of the same bad faith insurance companies' non-payments and improper claims payments practices which commonly exist on a pervasive widespread basis
To View The FBIC Good-Bad Faith Insurance Companies Ranking 100, click here...
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FBIC'S MISSION: Is to educate the American People and Others that to Insurance Companies, insurance is a business first. That Insurance Companies are no longer fiduciaries which is the way they were looked at many decades ago. That the overwhelming majority if not all insurers are to some degree or another bad faith insurers. Whether it be one claimant's claim willingly and intentionally illegally denied, many or most as a percent of claims that are illegally denied or where claimants are forced to go through other illegal bad faith insurance practices, is what separates insurers from being ranked Good Faith or Bad Faith insurers. FBIC's mission is to educate all of the Public as to Bad Faith Insurance Practices and in regards to their perception of Insurers and the Insurance Industry. FBIC looks to take the rose-colored glasses off of the People and help to make a very uneven playing field between Insurers-Policyholders-Claimants less dishonest, more honest and more level. FBIC recognizes that this will not be done or through legislation or regulation who for 200+ years are solidly in the pockets of insurers and the insurance industry.
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Here is an article exposing health care fraud within the medical profession:
http://www.fraud-magazine.com/article.aspx?id=4294976280
Most medical providers are honest and work hard to improve their patients' health. However, a few want to illegally increase the size of their bank accounts. Learn some of the basic health care provider schemes and how to deter them from taking some easy money.
Patients with Alzheimer's disease were sitting unsupervised inside a small room of a medical psychological care facility watching the movie "Forrest Gump" for the umpteenth time. Granted, it's a great movie, but each time the patients sat in front of the tube watching it, the facility submitted insurance claims for providing "group therapy."
I discovered this fraud during my investigation of the facility. It's just one of a long list of crimes committed by a handful of crooked medical providers.
Essentially, fraud in health care is just like in any other industry: Fraudsters with the means and opportunity take full advantage to unjustly profit. Health care crooks inside and outside the industry include patients, payers, employers, vendors and suppliers, and providers, including pharmacists. (Organized crime rings and computer hackers also play roles in committing health care fraud.)
The difference between the health care realm and many other industries is its huge, alluring, easy pile of cash. According to the Centers for Medicare & Medicaid Services (CMS), national health expenditures in the U.S. reached $2.6 trillion in 2010 — 17.9 percent of GDP. The CMS projects U.S. health spending to rise to 7.4 percent in 2014 as a result of the major coverage expansions from the U.S. Affordable Care Act (ACA) — an estimated 22 million people will be insured. Over the period of 2015-2021, health spending is projected to grow at an average rate of 6.2 percent annually.
Over the years, I've found investigating fraud committed by health care providers, facilities and institutions to be extremely fascinating, challenging and rewarding. Most associate those individuals and entities with only doing good and helping others. Although that's true of most health care providers and institutions, others do "go south."
In this article, I describe 10 of the common health provider fraud schemes I've found, and I include some cases I've investigated. This list definitely isn't inclusive, but it will get you started on understanding how providers can be tempted to defraud a lumbering system.
(Also see the ACFE's 2013 Fraud Examiners Manual's section on health care fraud — beginning with 1.1101 — to learn more about these and other types of fraud schemes.)
TEN COMMON HEALTH CARE PROVIDER FRAUD SCHEMES
Billing for services not rendered.
Billing for a non-covered service as a covered service.
Misrepresenting dates of service.
Misrepresenting locations of service.
Misrepresenting provider of service.
Waiving of deductibles and/or co-payments.
Incorrect reporting of diagnoses or procedures (includes unbundling).
Overutilization of services.
Corruption (kickbacks and bribery).
False or unnecessary issuance of prescription drugs.
These are the types of abuses that the PPACA seeks to address. And, as Knot pointed out, legislation improve this situation for all citizens is not equivalent in any way to the decision to take the country to war on 2 fronts or to gut the government's regulatory capabilities resulting in an economic death spiral and decimating the middle class.
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