What To Know About Insurance Fraud Investigations

Insurance agencies are in the business of helping people in need. Though you must turn a profit in the end, your primary goal is to protect people from the risks in their life. However, certain clients take advantage of their insurance and try to rig the system. Here is what to know about insurance fraud investigations as an insurance agent.

The Types of Insurance Fraud

Every insurance agency must know the warning signs that a client is trying to pull their leg for more money. There are two main types of insurance fraud: hard and soft fraud. Hard fraud refers to claims that are entirely fabricated from top to bottom. The insured will make up a story and damages in an effort to scam an insurance agency for money.

Soft fraudsters take a situation and embellish it out of proportion. These hyperbolic claims can make a small problem look much worse than it is. For example, a doctor could bill a patient for more procedures than were given, increasing the insurance payout from the patient’s provider. Whether you offer insurance for the patient or the doctor, you will want to know what’s going on and conduct a proper investigation.

How You Conduct an Investigation

An insurance fraud investigation is just like any other investigation—you need a convincing array of evidence to connect the dots and confirm past events. You’ll likely look into video recordings, patient logs, medical records, incident histories, eyewitness accounts, and more. Each piece of the puzzle will help you determine the legitimacy of the insured’s claim and whether they falsified their claim.

A Word of Caution

Every insurance agent and adjuster must be careful not to make mistakes or wrongly accuse clients. If you make such mistakes, it is best to have an insurance agent’s errors and omissions insurance policy. This professional liability insurance exists specifically for insurance agents and adjusters who need protection from their clients.

Learning what to know about insurance fraud investigations can help you fill in any gaps and move against suspicious claims.

Reasons Physician Assistants Need Malpractice Insurance

When you spend your time in front of patients all day, the likelihood of something going wrong increases. Grueling hours coupled with intensive care and nuanced treatment can prove disastrous. However, most medical professionals avoid mistakes day in and day out. Still, there’s always the chance that something could happen. Here are the main reasons physician assistants need malpractice insurance.

You Can’t Control Patient Responses

As a physician assistant, you focus on serving and treating your patients. However, the patients have their own interests at heart and they may not see the whole picture. The way you explain a procedure or give a patient treatment may not align with their personal values. A patient could change their mind about a medical procedure after the fact, but insist that it was the doctor’s fault. You can’t control what a patient says or does. If they level a claim of medical malpractice, you should have insurance in place to protect you.

You Can’t Stop All Errors

No one is impervious to error. In fact, it’s part of what makes us human. Though physician assistants endure years of intense schooling and training to avoid making any mistakes, they can’t help a slip of the hand or a mental oversight. Whether they admit it or not, every medical professional has made a mistake—minor or major. Since you can’t stop yourself from being human, it’s best to protect against any risk. If you don’t have malpractice insurance, you could face the financial, legal, and professional consequences of an honest mistake by yourself.

You Don’t Have Adequate Resources

Though they have higher salaries than average, medical professionals may have debts from school and other monetary responsibilities that make fending off a lawsuit financially devastating. Malpractice insurance coverage lifts that financial burden and equips professionals to handle any claim that comes their way. On your own, you can’t hope to fight a drawn-out legal battle, but with the help of an insurance agency, you’ll have all the resources you need.

Knowing the reasons physician assistants need malpractice insurance equips medical personnel to make the right career choices. If you need coverage, reach out to Baxter & Associates today. We offer premier malpractice insurance for healthcare professionals in many medical specializations, including physician assistants.