In the US, the ACA limits insurance company expenses and profits to a fraction of their actual, delivered care. They get paid more for providing more care, and it doesn’t matter whether that “care” actually reaches or benefits a patient. They’re fine with fraud, as long as it doesn’t grow so fast that they outspend their revenues. Gotta ride the wave of costs rising fast enough to justify next year’s raise, but slow enough to hold on to this year’s bonus.
These guys claim that as much as 20% of private insurance payments are fraudulent.
Its fraud. In many cases this would be insurance fraud. Why health insurance companies aren’t going after him is beyond me.
In the US, the ACA limits insurance company expenses and profits to a fraction of their actual, delivered care. They get paid more for providing more care, and it doesn’t matter whether that “care” actually reaches or benefits a patient. They’re fine with fraud, as long as it doesn’t grow so fast that they outspend their revenues. Gotta ride the wave of costs rising fast enough to justify next year’s raise, but slow enough to hold on to this year’s bonus.
These guys claim that as much as 20% of private insurance payments are fraudulent.
If they complain for that one, then they won’t get to use AI to deny treatments. Small cost for bigger profits