June 19, 2018

NICB Sees 23 Percent Rise in First Quarter 2011 Suspicious Claims

DES PLAINES, Ill., /PRNewswire-USNewswire/ — The National Insurance Crime Bureau (NICB) has released its first quarter 2011 questionable claims (QC) referral reason analysis. The report covers six referral reason categories of claims: property, casualty, commercial, workers’ compensation, vehicle and miscellaneous referred during the first quarters of 2009-2011.

In the first quarter of 2009, a total of 19,967 QCs were referred to NICB from its member insurance companies compared with 24,497 received in the first quarter of 2011—a 23 percent increase. Questionable claims are those claims that NICB member insurance companies refer to NICB for closer review and investigation based upon one or more indicators of possible fraud. A single claim may contain up to seven referral reasons.

With the exception of vehicle claims which were down four percent, all other claims categories were up. Property QCs were up three percent; casualty was up 25 percent; commercial was up 21 percent; workers’ compensation increased 24 percent; and miscellaneous claims were up by 25 percent.

Although QCs are initial referrals—not definitive incidents of fraud—they do provide an early warning statistical snapshot of potentially fraudulent activity that, when combined with NICB’s investigative and analytical resources, can quickly determine areas requiring additional industry fraud prevention and detection efforts.

“It is not surprising that this report finds increases in questionable medical-related claims,” said NICB President and CEO Joe Wehrle. “In recent years NICB has expanded its medical fraud task force operations to address the rampant fraud associated with illegitimate medical claims. From Florida to California, New York to Texas—wherever this kind of fraud exists, NICB will be there to fight it—not just for our member insurance companies, but for all consumers who buy insurance because, ultimately, they are paying for it through higher premiums. I urge all Americans to help us help them. Don’t tolerate fraud. If you suspect it, report it.”

The full report is available here (PDF).

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