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Insurance Fraud an Expensive Problem

Insurance Fraud an Expensive Problem

Posted - May 13, 2004 at 5:17 p.m.



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Jill Atwood ReportingHealth insurance fraud, it's a lot more common then you might think, and tonight two people are facing millions in fines and many years in federal prison.

It's a crime that's growing for two reasons, the rising cost of health insurance and Utah's diligence in investigating it.

30-year old Tracey Martin and his ex-wife Jennifer are in big trouble because even after their divorce, now over ten years ago, Tracey continued to file claims under his ex-wife's health insurance.

The problem with this case is FBI agents cannot find Mr. Martin. He's a convicted felon on parole and considered very dangerous, obviously not your typical white collar criminal. Tonight the FBI needs your help in finding him.

Bob Wright, F.B.I.: "He does have a very lengthy criminal history to include shoplifting, retail theft, and rx fraud, carrying a concealed weapon."

Now add to the list, 34 counts of health insurance fraud dating back to 1994. Joe Christensen with the Utah Insurance Department, says what the Martins did is becoming more and more common; in fact it's tripled in the last five years.

In Utah he's documented 6,000 people who have been married and then divorced, yet continued to receive health care benefits under their ex-spouse. That translates into millions of dollars.

Joe Christensen, Director, Fraud Division, Utah Insurance Dept.: "It's hard to afford for many people. More employers are providing fewer and fewer benefits, as you mentioned, for an individual to go out and buy it on their own is very expensive."

And as long as fraud goes on, it will get even more expensive. Health insurance fraud across the nation is estimated at 100 billion dollars a year. Split that up, that's 960 dollars per family in raised premiums.

Joe Christensen, Director, Fraud Division, Utah Insurance Dept.: "If you were robbed on the street and somebody pulled a gun out and stole $960 from you, you'd be outraged. But because it's insurance, you're nickled and dimed and it's not noticed as much."

So it's you and I paying for all this health insurance fraud. Also doctors are being closely looked at for the same thing, not putting down the right procedure so insurance will cover it.

Just know the Fraud Division of the Utah Insurance is very proactive in looking into these types of cases.

If you've got a complaint or a question you can contact the Insurance Department Fraud Division hotline at 1-877-372-8315.

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