NICB: Suspicious Claims in Florida Rise 22 Percent Since 2010

Describing the insidious activity that comprises all kinds of insurance fraud in terms of the long-term battle that it is, NICB President and CEO Joe Wehrle said in Orlando, “We have a shared responsibility to win this conflict. NICB, member companies, law enforcement, and anti-fraud organizations must present a united front to protect the American people.”

Addressing attendees today at the annual Insurance Fraud Management Conference, Wehrle gave a comprehensive overview of how NICB and its partners are attacking insurance fraud from a number of directions. He described how NICB established a post-Sandy command center and response team in New York to facilitate the information flow between insurers, regulators, consumers, law enforcement and NICB investigators to get in front of the fraud that, unfortunately, follows catastrophes like Sandy.

Wehrle described how NICB led the effort to share information between property and casualty insurers, the health care industry, Medicare/Medicaid and the U.S. Department of Justice, which resulted in the creation of the Health Care Fraud Prevention Partnership — an unprecedented union between these groups — all with the intent to prevent fraud, protect consumers and save tax money and insurance resources.

As an example of the level of suspected fraudulent activity in Florida, Wehrle discussed the latest NICB questionable claims (QC) report for the state that was released. In 2010, Florida generated 8,723 QCs. That number rose to 10,693 in 2012 — a 22.5 percent increase. QCs are those claims that NICB member insurance companies refer to NICB for closer review and investigation based on one or more indicators of possible fraud. A single claim may contain up to seven referral reasons.

Of the 10,693 QCs in 2012, 5,214 of them — 49 percent — came from just three counties, Broward, Palm Beach and Miami-Dade. Of those QCs, the referral reason most identified was personal injury protection (PIP) (2,534), followed by bodily injury (825) and “other auto” (601).

With a look at what the states could do to help in the fight against fraud, Wehrle identified areas of need. They include:

• Maintaining strong and effective state fraud bureaus with law enforcement powers, appropriate funding and resources, autonomy to conduct investigations and separation of law enforcement and regulatory authority

• Providing dedicated insurance fraud prosecutors

• Enacting strong anti-fraud laws and criminal penalties

As Wehrle often observes, “Insurance criminals do not discriminate; they will take money from any individual, or insurance company, or any local, state, or federal program lax enough to allow it. We must remain vigilant and flexible in order to prevail in this fight.”

Source: NICB