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Diagnosing Insurance Fraud

NCJ Number
110064
Journal
Security Management Volume: 32 Issue: 3 Dated: (March 1988) Pages: 60-62,63,64
Author(s)
J L Garcia
Date Published
1988
Length
5 pages
Annotation
This article describes the various methods and targets of insurance fraud and measures taken to prevent future abuse.
Abstract
Medical insurance fraud has increased as a result of the skyrocketing cost of health care in America. The means of medical fraud are varied, ranging from unsophisticated to complex conspiracies. Insurance fraud perpetrators focus their efforts in regions with high health care usage and low oversight. Patients also can be victimized by medical quackary. Legislation has been introduced in Congress to increase penalties for health care fraud. Several elaborate scams are described, including some implemented by organized crime. The National Health Care Antifraud Association (NHCAA) was formed in 1985 to combine insurance industry resources and information to combat health care fraud. In 1987, NHCAA developed a computer system to monitor health claims paid in Florida to detect patterns of excessive treatment or billing that cannot be discerned by any one carrier. At the moment, no program exists to coordinate information among self-insurers who have become a target of fraud perpetrators. Employers, however, can assist in the fight against fraud by helping educate their employees in ways to detect and prevent it. Listed are ways for patients to detect fraud.