Is this a form of insurance fraud? Provider charged us less than reported to insurance
We needed an expensive genetic test for our daughter. UCSF hospital suggested a new lower cost provider, and sent the sample in. The provider called us and said they are "unique" in that they would bill insurance a different amount than we actually would be held to.
Indeed. We paid them 0. They billed insurance 0, 49, and 84 all of which were paid at a [CO] rate since we're on a high deductible plan. As it sits we're out only 0, but our yearly deductible is nearly met according to UHC our insurance company.
Something seems fishy about this. I tried alerting UHC the insurance company, but I don't think they understood. Is this a form of fraud? If so who's making the money?
Note: After the sample went in, the test provider immediately called with a series of high pressure sales people, telling us the price would be 00, or we could apply for "special pricing", by submitting income data. They said "even if you make a million dollars" we'd be approved. It sounded really sleazy. We sent the data, and they dropped the price to 0.
They resisted putting this price in writing, but after several calls, eventually relented.
I won't name them in public, as I don't want to advertise their services even indirectly. If you're considering a cut rate genetic test however, you'll probably encounter them.
(1)1 Comments
Sorted by latest first Latest Oldest Best
Most states have an insurance regulator with a hotline you can call if you suspect insurance fraud to talk with someone about whether your situation might constitute fraud.
Since you mentioned UCSF I am assuming you are in California. I'm sure they would be happy to answer questions like this regardless of whether you want to file a complaint.
California Department of Insurance Fraud division
Here is their guidance about what constitutes fraud:
Fraud occurs when someone knowingly lies to obtain a benefit or
advantage to which they are not otherwise entitled or someone
knowingly denies a benefit that is due and to which someone is
entitled. According to the law, the crime of insurance fraud can be
prosecuted when:
The suspect had the intent to defraud. Insurance
fraud is a "specific" intent crime. This means a prosecutor must prove
that the person involved knowingly committed an act to defraud.
An act
is completed. Simply making a misrepresentation (written or oral) to
an insurer with knowledge that is untrue is sufficient. The act and
intent must come together. One without the other is not a crime.
Actual loss is not needed as long as the suspect has committed an act
and had the intent to commit the crime. No money necessarily has to be
lost by a victim.
You might be careful though. If you were complicit in this scheme you might technically be considered as a perp and not a victim in this scenario.
Terms of Use Privacy policy Contact About Cancellation policy © freshhoot.com2026 All Rights reserved.