DES PLAINES, Ill. /PRNewswire/ — The National Insurance Crime Bureau today released its first half 2011 questionable claims (QC) referral reason analysis. The report examines six referral reason categories of claims—property, casualty, commercial, workers’ compensation, vehicle and miscellaneous—for the first half of 2009, 2010 and 2011.
Questionable claims are 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.
During the first half of 2009, a total of 41,309 QCs were referred. That number increased to 46,766 in 2010 and to 48,887 in the first half of 2011. There was a 4.5 percent increase in QCs this year compared with 2010, and an 18.3 percent increase when compared with the first half of 2009.
Medical-related referral reasons generated significant QCs as did the category of vehicle hail damage. Under workers’ compensation, just two referral reasons—”inflated medical billing” and “duplicate billing” combined for a 445 percent change increase from the first half of 2010.
The full report is available here (PDF – Workers’ Comp starts on Page 5).