The big news in the world of insurance fraud this week is the announcement of the creation of the Consortium to Combat Medical Fraud.
The Consortium is a joint project of the coalition, the National Health Care Anti-Fraud Association and the National Insurance Crime Bureau. It’s the first time that property-casualty insurers and health carriers have come together in a meaningful way to better detect and investigate fraud by medical providers.
Activities underway include cross-matching data on suspected fraud cases, cross-training investigators, getting insurers comfortable with sharing information across industries and conducting research.
A joint education program last week drew more than 60 investigators from both sides. Many eyes were opened about the different approaches the two industries take to resisting bad claims, detecting fraud and dealing with fraudulent medical providers.
Case studies have made clear the advantages of sharing intelligence and developing joint investigative strategies. One obvious benefit is that prosecutors are more likely to take cases that cross industry lines.
A full story on this effort will soon be published in our quarterly newsletter, Fraud Focus, also available online.
In the meantime, there’s been a lot of good press this week about the announcement. But Sam Friedman, editor of the National Underwriter, writing in his blog, had one biting comment:
When we posted a news story yesterday reporting that “anti-fraud associations representing both the property-casualty and health insurance sectors will pool their resources to increase detection and prevention of health care fraud,” the first question that came to mind was, what took them so long?
He went on to answer his own question: I suppose I should not be surprised that the p-c and health-disability insurance sectors were off on their own all this time in trying to prevent fraud. While the public perceives the “insurance industry” as two sides of the same coin, the p-c and life-health groups have long operated as if they were two different currencies altogether.
He’s correct that the two sides of the industry have acted as if each has its own set of bad guys. As we have found, these fraudsters are equal-opportunity crooks.
This new effort should take a few more out of action.