Is it illegal to lie to an insurance company to obtain benefits for a patient?
Question Details: I work for a third party company who verifies insurance for patients to obtain specialty medication. We call health insurance companies and state we are calling for the drs office to obtain these benefits. A lot of times we get third partied and told they cannot provide us information. Recently my management team has told us to lie about where we are calling from in order to obtain the benefits. I know this is unethical but I was also wondering if lying to the health insurance company has any legal consequences. I want to make sure I do not break any laws by doing what my management team says and lying to obtain personal health information of a patient.
You and your employer could be sued for fraud for lying to the insurance company.
Fraud is the intentional misrepresentation of a material fact made with knowledge of its falsity and with induce reliance upon which the other party justifiably relied to its detriment.
In other words, the insurance company would not pay for the medication had it known the true facts.