Stealing health benefits no minor crime

adStealing health insurance benefits is a type of fraud that doesn’t get much attention. It seems innocent to a lot of people. So you list your boyfriend as your husband and get him covered by your employer’s policy. What’s the harm?

People who get divorced often don’t alert their employers that their now-ex isn’t really qualified for health benefits. And then there’s all the people who sign up for Medicaid that really don’t quality, like the doctor and school teacher in Connecticut.

All the same, it’s still cheating. Honest people pay extra for this dishonesty. And it’s dumb to steal insurance benefits because with vast data resources, insurers can easily learn about whether people are really married or whether their income is low enough to qualify for state programs.

The first public outreach effort on the theft of health benefits has been launched by the Insurance Fraud Prevention Authority (IFPA) in Pennsylvania. They’ve created a brochure, TV and radio spots, plus a website describing varied opportunistic frauds committed by consumers and warning people about the consequences. Another fine job by our colleagues in the Keystone State.

Question the company and their plan

Nevada adHealth care reform has helped produce a new wrinkle on an old scam. Crooks are taking advantage of consumer confusion over health care to peddle fake plans and worthless policies or insurance consumers don’t need. Health & Human Secretary Kathleen Sebelius is the latest to jump on the public awareness bandwagon to warn consumers about these scams. During a speech at the National Press Club earlier this week she said scam artists were going door to door telling people there was a limited open-enrollment period to buy coverage and they needed to buy now.

Sebelius, a former state insurance commissioner, said states need to investigate and prosecute these scams.

This new wrinkle comes atop a growing wave of bogus health plans and shady medical discount programs that are defrauding consumers by the thousands. Some states are taking action, such as the recent action in Tennessee where two sham health plans were taken over by regulators. Law enforcement also has ongoing criminal investigations in several states.

This is a good start. But more prevention is needed. That’s where alerts like the one issued by Sebelius and others come in. The best awareness campaign we’ve seen was just launched in Nevada. The campaign is a joint project of the state’s department of insurance, the Nevada Surplus Lines Association and the Nevada Independent Insurance Agents Association.

The campaign features tv and radio spots, a robust website and an interactive system to help consumers verify health insurers and discount plans. The website — — also contains red flags and useful tips on choosing a health plan.

The ads carry a double tagline — “Question the company and their plan” and “Check before you write a check.” Solid advice both.

State regulators have shown up a bit late for this party, partly because many budgets have been cut back for such things as consumer assistance. Perhaps if more took the lead from Nevada and partnered with industry groups, we might find a way to final get ahead of this crime spree.

“Scrap this bill”

Morgan CarrollThe Denver Post seems to be the voice of reason today in calling for sensible changes to workers comp legislation in Colorado. An editorial voiced its support for giving injured workers a greater say in comp policies, but cautioned against reining in anti-fraud activities.

House Bill 1012 is being amended again in the Senate Judiciary Committee, hopefully for the better by removing provisions that would require anyone conducting surveillance to reveal their operation if asked by a claimant (see previous post). The Denver Post has even better advice — scrap the bill altogether:

“The unfortunate truth is that some bad actors do try to cheat the system, and surveillance in the past has caught them doing such things as working construction jobs on the sly or performing other strenuous tasks while claiming they are too injured to work. HB 1012 also would require that evidence collected in investigations be destroyed after five years. Fraud investigators contend that’s too soon, and we agree. We see no harm in allowing investigators to keep what they find.”

The editorial also points out the obvious conflict of interest by Senate Judiciary Chair Morgan Carroll, an attorney who represents injured workers in workers comp cases. Sen. Carroll has a lot of influence in shaping this bill and in sending it on to the full Senate. Let’s hope she the committee do the right thing and at least delete the remaining onerous provisions.