Doctors and specialists have been scamming New Zealand's biggest health insurer, Southern Cross, which has just announced new measures in an attempt to save millions of dollars.
Stefan Azzopardi, the society's head of finance, risk and compliance, has released a statement telling of a "crack down on suspicious claiming and poor billing practices".
The claims from medical providers could include accidentally or deliberately billing for services not provided to obtain reimbursement, he said.
A new 0800 number has been launched to dob in dishonest claimants and a new fraud team was established in the last 12 months to try to stamp out fraudulent claims, possibly costing policy holders millions of dollars.
"Common sense tells us that when we're paying 73 per cent of the country's health insurance claims, we need to be vigilant as any unnecessary costs are ultimately met through premiums," Azzopardi said.
The society has a specialist team dedicated to preventing, detecting and investigating suspicious claims, whether they involve deception, poor administrative practices or billing errors.
The work from that team had so far saved members an estimated $1 million in ongoing annual claims costs and investigations are often due to member tip-offs.
"While the most obvious claims brought to our attention involve members who file claims for services or medications not received, or submit altered bills or receipts - billing and administration practices by a small number of medical providers have also posed challenges. With medical providers, given the potential patient volumes, claims we investigate can involve large sums and pose a much greater financial risk to the society," he said.
If shoddy or suspicious practices are suspected, the society investigates and where appropriate takes steps to recover funds.
The society can also ban members and has a range of actions that it is able to take against providers. In extreme cases, where criminal conduct or ethical issues are suspected, matters may also be referred to the police or an appropriate medical body.
Azzopardi highlighted several ways a member can help in the fight against suspicious claims:
• never sign a blank form and leave it with anyone - even a healthcare provider
• carefully check the details on invoices and your claims assessment advice to ensure they match the treatment received and costs paid
• don't be afraid to ask questions and query invoices.
He encouraged people aware of suspicious claiming behaviours or irregularities to confidentially call the dedicated hotline 0800 420 055 or email firstname.lastname@example.org