Forget Your Friends. 

The fact of the matter is, when you commit fraud you don’t really have friends.  You might start off thinking that you are playing Robin Hood – but it’s just not true.  You’ve got to stop being concerned about the little people and start worrying about old Numero Uno.  You know what we mean.  And remember that the little people can make big amounts of money reporting you to the authorities – all it takes is one whistleblower to report you.  Play it close to your chest!

Forget the Rules.

Rules are for losers.  People claim they don’t really know what fraud is, but you and I both know that’s just not true.  Fraud is cheating and lying – pure and simple.  Don’t waste your time and energy trying to justify it in your own mind.  Just keep pushing the envelope on every claim for every penny.  It’ll be worth it in the long run!

Forget How Fraud Begins.

One of our charter members Bernie Madoff didn’t get where he was overnight.  No sir.  It took years for him to get where he ended up.  And the more we find out about his little scheme, the less it looks like he really started out planning it.  The gates of hell aren’t paved with good intentions; they’re paved with the rational justifications of lots of itsy bitsy steps taken one at a time.

Forget Your Processes.

Get rid of those good, clean processes.  If you’ve got people in your office double-checking claims to EOBs to actual procedures, you’re potentially losing money!  Use lots of excuses like “We’re too small and just too busy.”  Or “We’re too big and just too busy.”  Remember that good processes breed efficiency – and efficiency is the hemlock of sneaky fraudsters like us.

Forget everything we just said.

Folks, this was all tongue-in-cheek.  We know that fraud is serious business and we really don’t want you to commit fraud or go to jail.  One way we know how serious fraud has become is due to all the training classes our insurance companies force us to attend so we can be on the lookout for fraud and abuse.  So let’s talk seriously about fraud for a couple of paragraphs.

On the one hand, the insurance industry commits vast amounts of both money and energy to watching and catching things most of you couldn’t even imagine.  (We’re really glad most of you are on the straight and narrow.  We were trying to come up with a way to circumspectly talk about specific cases of fraud and abuse, but we honestly don’t want to give people any ideas.)  On the other hand, and some of you are going to accuse us of being shills for big industry but we’re going to say it anyway, the fact of the matter is that even simple abuse ends up costing the very people you think you’re trying to help.  It’s a never-ending cycle of unaccounted fraud raising the rates for everyone.  Do just a little bit of research to find out what fraud actually does to this industry.  If fraud costs an insurance company $25M a year, do you think they’re going to foot that bill?  Nope – they’re going to make sure they adjust their rates for the next year to cover $35M worth of fraud.  (Just in case fraud goes up, ya know…)  Let’s face it.  Even if we gave you real numbers, you wouldn’t believe us.  Do your own looking and make active decisions for yourself.  Don’t let apathy and wishful thinking make your decisions for you.

                Adjusting information on a claim form in any way for the sake of ‘getting more money’ out of an insurance company is fraud.  It’s just not worth it.  Be honest with both your patients and your insurance carriers.  You’ll sleep better at night.

(c) Warschaw Learning Institute 2009
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