How to Identify Fraud to Save Money on Health Care

Why You've Got to Listen to This Episode...

In today’s episode, I’m talking with board certified nurse and trainer, Angel Cellucci about how to identify medical fraud.  Angel is on a mission to help empower individuals be better consumers of healthcare. She helps people make sure the medical care they get is necessary and offered at a fair and reasonable price. 

We’re talking about how often medical fraud happens, what you can do to prevent medical fraud, and how you can be more effective when you do have to advocate for yourself.

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Key Takeaways to Help You Identify Medical Fraud to Save Money on Healthcare

As always, we’ve rounded up our top three takeaways to summarize what we believe are the core points to remember from Angel. 

1 -Be an Active Consumer of Healthcare

Don’t assume your provider, medical facility or insurance, have it all figured out. Keep records, ask for an itemized bill, ask good questions, and stay involved and aware. This means asking your doctor what they’re looking for with a certain test they give you. And make sure to Google those codes if you’re not sure what they are.

Medical fraud is way more common than you would imagine. When we are more aware, and we are more involved in every stage of our care until those bills are paid, we’re more likely to get the care we need and save more money for ourselves – now, and in the future.

2 - Protect Your Health Insurance Information

Make sure to protect it just like you would protect your social security number and your banking information. Fraudsters try to steal health insurance information to build false charges and use your care illegally.

As Angel mentioned, if you have Medicare or Medicaid, or you have a parent that does, be aware that people trying to commit fraud look for Medicaid and Medicare bills opportunities first.  They assume those consumers aren’t looking at their bills because those consumers tend to not be the one paying them. They look at it like a blank check.

You want to stay aware of what those charges are and what is happening for many reasons. For one, all of those diagnoses go on your medical record. This could impact future care. 

For example, what happens if you go to a hospital in an emergency? Are you coded as having the wrong blood type or as having recently had pneumonia when you didn’t have any of those thing happen? This is not a risk worth taking. 

3 - When Working to Correct Errors or Fraud and Medical Billing, Always Be Kind

Simply stated, don’t shoot the messenger. The person on the other end of the line is also spending their days looking at billing, coding and trying to find errors and working with patients. Go in with calm, thought-out questions.

Know your facts. You’re going to have all those records, just like in our takeaway from step one. That means you kept records, you looked at your itemized bill,  and you went to Healthcare Bluebook. 

When you know your information so you can stand firm while still being nice, it’s more likely that you will get what you need to go faster. Plus, it’ll make your own experience a lot easier to handle.

We want to make sure you save money and that you are not paying for medical care you didn’t receive. Or that you aren’t paying insane prices for things like “mucus recovery systems” -aka- Kleenex. Just make sure you’re kind with everybody that you deal with, including your pharmacists, your providers, and your billing people.

Links & Resources Mentioned

Connect with Angel

Angel Cellucci is a woman on a mission! Her goal is to leverage her nursing and medical experience, along with her fraud investigation skills, to educate and empower individuals to become better consumers of healthcare so they can ensure they are receiving medically necessary treatment at fair and reasonable prices. She is a Board-Certified Family Nurse Practitioner and the owner of two medical fraud investigation companies: Medical Fraud Fighters and Overbrook Consultants.

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