We know that Brazil is an extremely bureaucratic country, especially in relation to tax and fiscal issues. Also for this reason, the country faces serious fraud problems in healthcare and other market segments. Given this reality, knowing how to avoid misuse of health plan services can be essential for your finances.
Even though these practices are increasingly sophisticated and executed with precision, there are ways to minimize the chances of them occurring or even prevent your budget from being affected by any eventuality. Want to find out how to do this? Then check out the content below.
What are the common deviations in health plans?
Although health plans are among the most desirable benefits for the vast majority of Brazilians, we know that they tend to have considerable price increases. And, without a shadow of a doubt, one of the biggest factors that contribute to this is abuse, misuse and fraud, which generate considerable losses every year.
Among the most common situations of this kind are users who request undue refunds or who request multiple receipts when undergoing a single consultation. Another harmful behavior is some uses of laboratory tests, which are often unnecessary and, eventually, are not even removed.
Other possibilities are falsifying documents to benefit third parties or even lending your health plan card to other people. We may also see cases of withholding important information and omitting pre-existing illnesses or injuries when making the settlement.
However, the most common fraud has occurred when hiring, in joining false collectives aimed at specific classes, in which people who do not belong to the categories are included. It is not difficult to see that those who pay the bill in the end are the companies, through their premiums and adjustments, with a direct impact on increased costs.
How to promote good practices in health plans?
The best path is, of course, to prevent fraud from occurring in all ways.
In hospitals, offices, clinics and healthcare providers themselves, adopting some measures can be a very effective strategy. Among them is investing in the training of customer service employees, so that they can correctly check patient identities and data.
Another possibility is the creation of slightly stricter rules and procedures for carrying out any procedures, as well as the use of biometric identification technologies and software to check the information of those who will undergo consultations or exams.
Finally, it is worth investing in better guidance for doctors on the exam request processes and monitoring by a legal, administrative or labor professional for possible guidance.
As we can see, as much as they can be a tremendous problem, all types of abuse and misuse in healthcare are part of the daily life of any company working in the sector and, in general, these are situations that can be avoided, which means which benefits everyone involved.
Did you enjoy learning a little more about healthcare fraud? Do you have any questions or do you have a suggestion? So, leave your comment here on the post!
