Worker's comp claims a primary concern for fraud investigators

One of the primary concerns of any insurance company is fraud. The issue of unscrupulous people trying to get money to which they aren't entitled is a problem for any industry, but particularly those that deal so much with self-reported claims. This year, medical, auto and workers' compensation predict to be sectors particularly worthy of keeping an eye on, according to statistics collected by the National Insurance Crime Bureau.

The high amount of fraud in the medical and workers' compensation fraud cases promises to be particularly relevant for the contractor liability insurance industry. Because the job is so inherently dangerous, having proper coverage for any employees who may get hurt on the job is a must. However, some people may very well attempt to take advantage of this policy.

According to the Roger Morris, the bureau's Chief Communication Officer, the primary issue is "malingering." This refers to the practice of continuing to get medication or benefits, long after they've ceased being necessary. Such tactics can add further stress to an already strained provider system.

Another common grift is staged accidents. In these cases, the crime is often organized, and includes a variety of players including doctors, lawyers and physical therapists. By generation false claims, all of these criminal elements can hike up their profits without actually performing any sort of service. Morris in particular highlighted the need to crack down on shady clinics.

"We need to tweak some of the laws and so forth to tighten that up because they know where the loopholes are. They go in there and open operations, and they'll have a clinic going for a month or two billing millions of dollars and then shut it down and move it to another location before anybody has an idea of what was going on," Morris said.

Insurance fraud is a particularly insidious type of crime, because it doesn't just affect those who are forced to shell out money or care for those that don't need it. It also ties up hospital resources on phony claims, prevents those that actually need help from getting it and raises premiums for those who haven't done anything wrong. The more the National Insurance Crime Bureau can crack down on this malfeasance, the better off we'll all be.

 

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