Fighting fraud is becoming more meaningful to most insurers, research indicate. The Washington, D.C.-based Coalition Against Insurance Fraud (CAIF), for instance, found that 86% of insurers track the percentage of claims they refer to their SIUs and that 39% refer between one percent to three percent of claims.CAIF found that 80% of insurers track how much money anti-fraud activities save their companies, while 11% of insurers rate their investigators based on how much money they save the company.
James Quigley, CAIF's director of communications, says health insurers have had a tough year dealing with complex fraud schemes, such as "rent a patient" where a fraud perpetrator recruits low-income or minority patients and pays them a substantial sum of money to visit clinics solely for unnecessary diagnostic tests or surgery. The clinics then bill the insurance company an inflated amount for procedures that were done.
Register or login for access to this item and much more
All Digital Insurance content is archived after seven days.
Community members receive:
- All recent and archived articles
- Conference offers and updates
- A full menu of enewsletter options
- Web seminars, white papers, ebooks
Already have an account? Log In
Don't have an account? Register for Free Unlimited Access