Time for pursue fraud-busting resolve for 2015

Stronger laws, better funding will move fraud fight to next level

New YearsIt’s that time again. Millions peer ahead to the new year with great expectations. That includes the anti-fraud community.

So here are several of the Coalition’s resolutions for 2015:

• We will diligently strengthen the anti-fraud effort. Getting lagging states with weak fraud laws to enact strong new ones is a big emphasis.

• We will keep up the drum beat so fraud stays a high-profile news item around the U.S. This will alert consumers to protect against being duped by shady operators, and deter fence-sitters from committing this crime.

And some resolutions we’d like others to make:

New York legislators: We finally will strengthen the state’s no-fault auto laws to lower the expensive “fraud tax” honest drivers pay in higher premiums.

New Jersey legislators: We will pass laws that chase down drivers who illicitly use out-of-state addresses to avoid paying higher New Jersey auto premiums. We also will expand the state’s immunity law to allow more sharing of case information among anti-fraud groups.

Michigan legislators: We will fulfill the aspirations of the anti-fraud community by creating an auto-fraud authority to help combat widespread no-fault scamming in the state.

Minnesota legislators: We will pass leftover anti-fraud measures that were removed from the larger fraud bill enacted in 2014.

U.S. Congress: We will properly fund the Healthcare Fraud Prevention Partnership so it can uncover health schemes that target both private and public health insurers.

The new year will be rife with promise and opportunities to move the fraud fight to the next level. Rest assured that Coalition will be front and center, helping transform that raw promise into great progress.

Happy fraud-busting New Year!

About the author: Howard Goldblatt is director of government affairs for the Coalition Against Insurance Fraud.

Michigan needs an auto-fraud authority

Push as stand-alone bill to tackle widespread staged-crash rings

Over a year ago I wrote that there’s no such thing as a “no-brainer” when it comes to passing legislation. Issues are harder to move forward when observers think they’re a “no-brainer.” I wrote that blog with Michigan in mind.

Michigan is one of the two most populous states without an infrastructure to tackle insurance fraud. There’s no fraud bureau, fraud authority or dedicated prosecutors. There’s no state agency to investigate and prosecute suspected frauds.

Several years ago the Coalition worked with anti-fraud partners to help craft a bill creating a fraud authority to target widespread auto-fraud schemes in Michigan. Staged-crash rings were among the offenders needing stifling.

The authority would have a statewide board funded by an assessment on auto insurers. The funds would be distributed as grants to law enforcement statewide, local prosecutors and others to chase down auto scammers. Michigan’s legislation was modeled after the Pennsylvania Insurance Fraud Authority, which is a successful statewide anti-fraud effort.

In advocating legislation for a fraud authority, legislators had difficulty understanding that auto insurance fraud is a statewide concern instead of a local issue. Then the state police pushed back, fearing they might lose funding for their own auto-theft authority. Those concerns eventually were resolved.

The fraud authority was a stand-alone bill. But that changed a couple of years ago when the governor, many legislators, opinion leaders and insurers decided Michigan’s entire no-fault auto insurance system needed an overhaul. So the fraud authority was rolled into the current comprehensive no-fault reform package. That has tied up efforts to pass an auto-fraud authority.

Several versions of large scale no-fault reform have fizzled, and the auto fraud authority went down with the doomed bills each time.

Michigan’s statehouse is about to close for the year, with a new legislature and leadership coming in 2015.

It’s time to rethink the issue. The auto-fraud authority should stay free of large reform bills, which often collapse from their own weight and complexity. The agency should be introduced as a stand-alone bill. It has wide support, and stands a far better chance of passing that way. Michigan drivers and fraud fighters deserve nothing less.

About the author: Howard Goldblatt is director of government affairs for the Coalition Against Insurance Fraud.

No-fault repeal could harm lower-income drivers

Quashing system could delay medical treatment for injuries

The no-fault PIP auto insurance system was created in the 1970s with noble intentions: Resolving crash claims in a timely manner, regardless of who’s at fault. The concept still works to a degree. But the unintended consequence has been the large growth of fraud schemes.

Few policymakers thought PIP would become a cash cow for scammers when the system was enacted in Florida, New York, Michigan and other states. But adaptive fraudsters quickly learned the loopholes to exploit the system to steal hundreds of millions of insurance dollars or more in false crash-related claims.

Florida, New York and Michigan have tried to reform PIP and strengthen the anti-fraud provisions in the last few years. Policymakers in those states believe no-fault still is viable. Yet there are rumblings in Florida about repealing PIP and installing a system similar to Colorado’s after that state repealed no-fault in 2004. Rampant no-fault fraud is the main factor driving calls for repeal in Florida, most recently by the editorial writers of the Palm Beach Post.

Who does repeal benefit and harm the most?

PIP clearly helps low-income drivers, especially those who cannot afford private health insurance. Their auto crash injuries are quickly taken care of under PIP. What would happen if PIP is repealed?

One of the intents of the Affordable Care Act is to expand the availability of health insurance to all — especially low-income Americans. Much of this would be achieved by expanding Medicaid eligibility, which lets states insure more poor residents.

But not every state expanded Medicaid, including Florida. Without expansion, no-fault repeal could leave the working poor — those not eligible for existing Medicaid coverage — with few options for affordable medical treatment. Yes, they would be compensated for their injuries if the other driver is at fault, but in situations where fault may be in question, the wait can be long, causing lapses in treating injuries.

The Coalition has no position on whether states should repeal PIP. But policymakers considering such a tumultuous change, especially in Florida, first should remember why their state enacted no-fault in the first place. Without no-fault, they also may have figure out how assist more lower-income residents.

If expanding Medicaid is the tradeoff for dumping no-fault, then perhaps those who advocate repeal ought to lobby the governor in Florida to expand Medicaid.

About the author: Howard Goldblatt is director of government affairs for the Coalition Against Insurance Fraud.

Will Republican surge affect anti-fraud efforts?

Fraud fighters must be well-mobilized no matter who’s in power

The impact of yesterday’s elections on anti-fraud efforts around the U.S. will become clearer once the results are analyzed in more detail.

Certainly the Republican sirocco that swept through the elections is shaking up an order that has opposed and supported state anti-fraud efforts.

For the most part, however, state anti-fraud legislation and budget funding are driven less by party lines and more by the priorities of the men and women who hold office.

Also look to powerful gate-keeping committees that decide which bills reach the floor. Complex insider agendas, alliances and political tradeoffs frequently affect bills far more than broad party affiliation. Politically powerful special-interest groups also can stall or push measures regardless of which party holds sway.

Still, the election results hint generally at things to come in several hot-button states.

Republicans gained control of the state House in Minnesota. That rattles a power structure that worked against fraud fighters this year. The chair of the House Commerce committee gives up his position. His committee gutted a promising bill that would’ve added civil penalties for fraudsters, tightened rules against bogus medical billing and treatments, and allowed dishonest medical providers to be booted from the insurance system.

This power shift may open the door for a fresh revisit of the bill.

Florida’s CFO was reelected. Jeff Atwater has taken strong anti-fraud stands in a state wracked by debilitating crash rings and medical fraud. Atwater’s continued presence could ensure a continued department-level priority on rolling up scams. Legislation to tighten the noose is murkier. Larger agendas involving reforming or even dumping the state’s no-fault auto system could surface. The future of fraud reforms could hinge on the outcome of those larger issues.

Oregon re-elected a governor who vetoed a bill making insurance fraud a crime a decade ago. That creates a political environment that looks ill-suited for passing a bill in 2015.

Kansas insurance commissioner Sandy Praeger is retiring. She was a stalwart supporter of anti-fraud efforts. Will her successor show the same commitment?

Closely watch Pennsylvania, Illinois, Massachusetts and Maryland. Those states elected governors of the opposite party. They’ll likely install new insurance commissioners. Their anti-fraud priorities will merit close scrutiny.

New York’s statehouse has consistently stalled much-needed legislation clamping down on staged-crash rings. Nothing in yesterday’s voting seems likely to change that. Only the governor’s active backing can break a logjam that has lasted for several years.

Bills expanding the ability of insurers and regulators to share case information may be the one issue that benefits from the Republican surge. Giving insurers more leeway could be something that corporate-friendly legislators and regulators would support.

Special-interest politics has been a larger factor throughout the years than Red vs. Blue.

The well-funded and politically mobilized trial bar was a big factor in derailing the Minnesota bill and a Michigan measure creating an automobile-fraud prevention authority — both this year. The trial bar also reared up against no-fault fraud reforms in Florida in 2011 and 2012.

The bottom-line takeaway: On balance, fighting fraud crosses party lines. Putting a big dent in crime is a universal goal. Democrats and Republicans have fought hard for anti-fraud bills, and helped thwart them. Fraud fighters must be well-mobilized regardless or who’s in power. They must be prepared to build strong cases that anti-fraud bills are pro-consumer. Just as important, they must build close relationships with committees, and with members of the broader legislature.

This is closer to the universal roadmap for influence and impact. For fraud fighters, the issue is less Red or Blue, and more Red, White and Blue.

About the author: Jim Quiggle is director of communications for the Coalition Against Insurance Fraud.

More states taking on vehicle rate evaders

Drivers falsely registering in states with lower premiums

Dishonest drivers are ginning the auto-insurance system by illicitly registering their vehicles in states or counties with lower auto premiums. These cheaters may not drive or live there, but dishonestly setting up the address can save them a bundle on auto premiums.

This insurance scheme may cost honest consumers and the insurance system millions of dollars. And in some jurisdictions the drivers are committing insurance fraud.

Years ago the then-Philadelphia DA offered amnesty for dishonest drivers to step forward and properly register their vehicles in Philadelphia instead of their falsely claimed addresses in the Philly suburbs or southern New Jersey. A number of folks set their registration record straight — including an employee in the DA’s office.

More recently, North Carolina knew it had a problem with out-of-state drivers registering in the Tar Heel State. North Carolina now requires drivers to show proof of residence before they can register and insure their vehicle.

Several weeks ago the New Jersey Assembly passed a bill targeting drivers who lie about where they garage their vehicles. The state would gain more authority to go after these insurance cheaters if the bill becomes law.

New York has seen insurance investigators, consumer and community groups identify numerous suspicious vehicles parked in residential neighborhoods in Staten Island and Brooklyn. The vehicles oddly had license plates from Virginia, North Carolina, Pennsylvania and Iowa. Visiting friends or relatives don’t own these vehicles. They’re driven by New Yorkers who are cheating the insurance system.

An agent also may be helping New York drivers register vehicles in a state hundreds of miles away, confidential sources say. These drivers are cheating the system. They are raising the insurance risks and possibly auto premiums in the target state. They also are paying lower auto premiums without lowering the insurance risks in New York.

Neighborhood groups, anti-fraud groups and some legislators would like to make false vehicle registering a crime of insurance fraud in New York. A bill awaits action in Albany.

Most states have yet to make illegal registering a specific insurance crime. For the most part, we’ve also seen only sporadic enforcement. Still, more auto insurers and states are starting to realize that false vehicle registering can lead to other insurance crimes such as bogus vehicle injury or theft claims. Stopping rate evasion thus can help in the larger fraud fight.

States should step up and realize that rate evasion is an insurance fraud that needs targeting. It’s good for honest consumers and the insurance system.

About the author: Howard Goldblatt is director of government affairs for the Coalition Against Insurance Fraud.


Give health insurers a break from loss ratios

Move will help fight healthcare fraud — and help put downward pressure on premiums

A columnist for the Los Angeles Times recently skewered UnitedHealth for what he says was aiding and abetting a $43-million medical scam involving bogus weight-loss surgeries.

The health plan failed to scrutinize bad claims, the columnist says, until long after money was out the door.

Whether or not the harsh criticism is justified, we’ll leave to others to debate. But if UnitedHealth and others are not investing in expanded anti-fraud efforts, there’s likely a good reason:

Federal law discourages it.

One of the least publicized provisions of the Affordable Care Act is intended to make health insurance more affordable. Health reform governs the percentage of premiums health plans can dedicate to non-claims business expenses, such as marketing, salaries, administration, profit and yes — anti-fraud activities.

The so-called Medical Loss Ratio requires health plans to spend 80 to 85 percent of premiums they collect on claims.

In essence, anti-fraud expenses must be paid out of profit. That’s enough to discourage most health-insurance companies from growing their anti-fraud programs.

In some instances where insurer expenses are out of balance, paying suspect claims could boost profits — or at least not affect them. Now most health insurers wouldn’t intentionally pay suspect claims, but bad claims can be harder to detect when the anti-fraud efforts haven’t grown commensurate with the growth in policies and claims.

And thanks to Obamacare, policies and claims are growing. But anti-fraud efforts are not.

The Medical Loss Ratio is a good idea in theory. It prevents insurers from spending all the new-found premium money on frivolous expenses, such as corporate bonuses.

But good legislation also has unintended consequences — such as discouraging investment in fraud.

If fraud is allowed to increase — such as the $43 million that reportedly was spent on unnecessary and phantom stomach lap-band surgery — then upward pressure will continue on premiums, and everyone loses — except the fraudsters.

The time has come to rethink how the MLR is calculated.

About the authors: Dennis Jay is executive director of the Coalition Against Insurance Fraud. Howard Goldblatt is director of government affairs for the Coalition Against Insurance Fraud.

Medical marijuana as a strategy to reduce prescription drug deaths

New study contains strong evidence that painkiller alternatives can save lives and insurers money

After visiting a medical marijuana outlet in Colorado in May, I wrote about the possibility of medical marijuana replacing addictive opoids to help chronic pain sufferers.

A new study says that states that allow medical marijuana consistently had fewer overdoses than other states.

Medical marijuana states reported an overdose death rate of nearly 25 percent less than states without the laws, according to an analysis of data from the John Hopkins Bloomberg School and the Philadelphia Veterans Affairs Medical Center. The correlation between death rates and the availability of marijuana for medical purposes seems very strong.

Hopefully, this new evidence will spur Congress to allow researchers to test of efficacy of marijuana as pain medication. Good studies are lacking because of current law outlawing the possession of pot makes it nearly impossible for researchers to conducted this needed study.

About the author: Dennis Jay is executive director of the Coalition Against Insurance Fraud.

Ridesharing: Old laws, regs collide with new technology

Explosive industry raises concerns about fraud, and who’s covered when

The issue of ridesharing has exploded in recent months. Concerns about whether the drivers have proper insurance are just one of the questions raised by regulators, insurers and consumer groups. Insurance fraud is a side concern for now, but is growing with the rideshare industry.

News coverage has mostly focused on state and local oversight of ridesharing, and complaints by local taxi drivers and companies about their new competitors. In the past several weeks taxi drivers here in Washington D.C. demonstrated against the ridesharing firm Uber’s growing presence in the nation’s capital.

Cabbies are worried that the largely unregulated rideshares will cripple the mainstream taxi industry. Ridesharing firms should meet the same regulatory standards as taxis and other for-hire vehicles, the cabbies argue.

State insurance regulators, state attorneys general, consumer groups and local taxi commissions increasingly are vocal about insurance and oversight issues. The California insurance commissioner has actively voiced insurance concerns. A big question is for rideshare drivers to manage auto coverage so a private vehicle is covered when it’s operating both privately and as a commercial rideshare.

I have a friend who owns a livery service. He’s affiliated with Uber. He has an app on his smartphone that when turned on tells Uber he’s available to pick up passengers.

We talked while he drove me to the airport recently. He has a proper state license and insurance for livery use of his vehicle. Still, he’s unsure when Uber’s auto policy protects him when driving an Uber passenger, and whether Uber’s insurance covers him while driving to or from picking up a passenger.

This raises questions about insurance fraud. At least one insurer has been reported to denying several damage claims by San Francisco rideshare vehicles the insurer says were personal vehicles used commercially. Several fraud-related issues thus arise from this new industry:

  • Do ridesharing drivers and cars have adequate insurance to act as a commercial driver and vehicle?
  • Does a rideshare driver’s personal-auto insurer know that the vehicle also is being used commercially?
  • Is the driver lying to his or her personal auto insurer that the vehicle is used commercially for part of the time?
  • Is the driver filing a fraudulent personal auto claim for a loss that occurs when driving commercially?
  • What protections do injured passengers have if the personal auto insurer denies claims because the vehicle was used as a rideshare outside the scope of the policy?

Ridesharing reveals how 21st technology is outstripping laws and regulations that have been mainstays for at least a century. Consumers can use a smartphone to arrange a ride without hailing a taxi from a street corner.

Clearly we are heading into a new era. Taxis are heavily regulated. Laws and regulations must be updated and adapted to ridesharing — it is here to stay. Fraud fighters must ensure that ridesharing companies do an honest business with their insurers — and the consumers entrusted to their care.

About the author: Howard Goldblatt is director of government affairs for the Coalition Against Insurance Fraud.

Statehouses already shuttering for 2014

Summer slowdown buys time to pivot to 2015

June 1 is the start of meteorological summer and hurricane season. It’s also when government affairs folks start pivoting from the current legislative sessions to planning for 2015.

Most state legislatures open only briefly, and that’s during the first half of the year. We’re still nearing the 2014 midpoint yet few legislatures remain in session. Nearly all will be shuttered for the year by the end of June.

Let’s step back and review this year’s legislative results to date, then talk about pivoting in more detail.

We predicted a robust year for anti-fraud bills and laws in 2014. The stronger economy freed up more time for legislators to deal with issues like fraud, instead of single-mindedly balancing cash-strapped state budgets. To a large degree, we were right. Dozens of bills were introduced, and many became law.

In a large respect, the year has been a healthy success. Our bill tally is down from last year’s record totals. The downtick points to a phenomenon that affects statehouses every state election cycle …

This is an election year. Many states will elect governors and state legislators this fall. The rule of thumb is “Do no harm.” Make as few ripples or controversy with voters as possible — quietly slide through and get reelected. Many politicians in both parties thus backed away from serious lawmaking this year.

Still, the year has produced numerous useful fraud laws. Among them: Three states enacted counterfeit airbag laws, and seven states considered stronger contractor laws.

Colorado enacted a felony insurance-fraud law. Maryland booked a venue law helping define where to best try fraud prosecutions. Louisiana expanded its insurance-fraud law: Impersonating an insurer to steer crash victims to crooked medical providers or repair shops became a crime of insurance fraud. Minnesota enacted a wider immunity law allowing more exchange of valuable case leads and other information.

With a healthy year on record, the 2015 pivot already is underway. The Coalition’s government affairs committee soon will look at at potential target states for much of the summer. Then we’ll create a roadmap of fraud bills to pursue in key states next year.

We encourage your insights. You may have grassroots knowledge of fraud issues in certain states. Send us your ideas for issues and states the Coalition might target for 2015. Contact me at Howard@insurancefraud.org.

You know the Coalition’s lengthy background, and you know the Coalition can help move and anti-fraud initiative in your state. So don’t hesitate to reach out.

About the author: Howard Goldblatt is director of government affairs for the Coalition Against Insurance Fraud.

Enforcement can have unintended consequences

Do better fraud-busting reveal uncontrolled crime or solid enforcement?

Social scientists call it the “Law of Unintended Consequences.” That’s when an action creates results that aren’t expected when the action was contemplated.

Strengthening insurance fraud laws or increasing enforcement of existing laws can have its own unintended consequence: Fraud might appear to be spiking. Yet that could be an illusion. Better enforcement may simply be uncovering crime that already exists.

The Coalition worked with legislators and the insurance department to enact a strong anti-fraud law in a Great Plains state several years ago. A year or so later, I ran into one of the legislators we worked on the bill and asked him how it was going. “We didn’t have any fraud until you guys showed up,” he kidded me.

Fraud wasn’t being investigated or reported to law enforcement before the law took effect. Insurers began investigating and reporting the crime to law enforcement after the measure took effect.

Fraud seemed to be spiking. But maybe the opposite was taking place: Stepped-up enforcement could’ve started diminishing this crime.

Oregon is the only state without a specific insurance-fraud law or fraud bureau. That means few investigations or prosecutions happen. It creates a false sense of security, that insurance fraud barely exists in the state. Yet, we in the anti-fraud community know otherwise.

If Oregon enacts a needed fraud law, the welcome boost in enforcement could suggest a seeming crime spike. The populace would need to be carefully educated that fraud isn’t necessarily running out of control. Instead, fraud fighters may be just doing a really good job.

Incidence of suspected fraud spike and fade for all kinds of reasons. A state may start to enforce its mandatory fraud reporting requirement and all of a sudden, the number of cases skyrocket. Or as we’ve seen during the 2009/10 recession, fraud bureau budgets can cut, and the number of cases dwindle.

I was reminded of unintended consequences last week when the Social Security Administration released a video last week that noted “Social Security’s zero-tolerance approach has resulted in a fraud incidence rate that is a fraction of one percent.”

Just goes to show that you don’t really have a fraud problem if you don’t bother looking for it.

About the author: Howard Goldblatt is director of government affairs for the Coalition Against Insurance Fraud.