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In recent months, a new type of fraud has spread in medical insurance: treatment costs are inflated, unnecessary procedures are requested, among other activities. Today on the LEX & CO blog we will tell you everything you need to know.


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AMIS Fraud Alert

The Mexican Association of Insurance Institutions (AMIS) has warned about these practices so that policyholders stop falling into them. They are usually carried out between insurance agents and intermediaries, who persuade their clients to seek care at certain hospitals, request unnecessary procedures or inflate the costs of treatments.

According to an interview in the newspaper El Universal with Gerardo de la Garza, president of the Mexican Association of Insurance and Surety Agents (AMASFAC), these managers can earn between 20,000 and 30,000 at the expense of the insurer, and even greater amounts.

While this fraudulent activity is not new, it has been handled discreetly and is often noticed by insurers and hospitals.


What does this fraud consist of?

Fraud is usually committed by intermediaries between the end consumer, the insurer and the hospital. These managers recruit their victims through social networks and promise them that they will not have to pay deductibles or additional costs for the medical care received. To do this, hospitals collaborate to inflate the costs of services, or managers request payment as a commission for their services.

This practice is common in group accounts, where they are promised insurance for medical expenses and services that may put their health or physical integrity at risk, especially when they undergo medical or surgical procedures that they do not need.


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Insurers’ reactions

Insurers have taken action to prevent fraud in their name. However, these frauds not only affect the people who have been victims, but also the insurers and clients since the increase in claims due to fraudulent practices increases the costs that insurers face for offering medical expenses insurance.

The increase in costs can cause insurers to make decisions such as raising the costs of deductibles, premiums, coinsurance, restricting the type of coverage and modifying hospital networks.


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Avoid being a victim of fraud!

If you want to take out an insurance policy, go to the insurers’ offices, investigate offers, costs and benefits. Do not give your confidential information to unidentified personnel or sign blank documents.

And if you have already been a victim of fraud, contact us. At LEX & CO we are insurance attorneys and we will represent you to get the justice you need. Write to us through the WhatsApp button, online chat or through the contact form to tell us about your case or request information about our services. Learn the Art of Winning.

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