Research bibliography

Below is bibliographical information about various studies, white papers, testimony and other documents on insurance fraud collected by the Coalition. Some of this information will be available to download in the future. Article designated with an asterisk are available in hard copy to Coalition members. Some listings also contain contact information to obtain copies from authors. To suggest additional listings, please send an e-mail to research@insurancefraud.org.

Addressing Fraud and Abuse in Health Care
AARP

A summary of the anti-fraud provisions in the Health Insurance Portability and Accountability Act of 1996. Number of pages: 4. 12/1/96

Keywords: Health insurance


America Speaks Out on Health Care Fraud
American Association of Retired Persons

Survey of attitudes toward health care fraud. Includes questions about potential ways to combat fraud and what people would favor. Number of pages: 28. 9/1/97

Keywords: Public opinion
Health insurance

Other information: Contact: AARP, 601 E St. N.W, Washington, D.C. 20049. Phone (202) 434-2277.


Report of the Anti-Fraud taskforce*
American Council of Life Insurance

Overview of fraud among claimants and agents, current remedies, as well as recommendations to the association of ways to combat the problem. Number of pages: 32. 10/20/93

Keywords: Life insurance


Workers Compensation-A Guide for Policymakers
American Legislative Exchance Council

Overview of the history and current workers compensation system. Includes a chapter on fraud. Number of pages: 78. 3/1/99

Keywords: Workers compensation

Other information: Contact: ALEC, 910 17th St. NW, Fifth Floor, Washington, D.C. 20006, (202) 466-3800, fax (202) 466-3801, www.alec.org, info@alec.org.


Health Care Reform: How Proposals Address Fraud and Abuse*
Aronovitz, Leslie G.

Testimony before two subcommittees of the U.S. House Committee on Government Operations. Compares anti-fraud provisions of four major proposals during 1994 health care reform debate. Number of pages: 24. 3/17/94

Keywords: Health insurance

Other information: Author is associate director, health financing issues of the GAO's Health, Education and Human Services Division.


Fighting the Hidden Crime: A National Agenda to Combat Insurance Fraud*
Baker, K. and Edelhertz, H.

A seminal study of the nature and extent of insurance fraud that attempts to define the arenas in which work will have to be done to fight fraud. Suggests a number of potential solutions and makes recommendations in each area. Number of pages: 53. 3/1/92

Keywords: General

Other information: Publisher: Battelle Seattle Research Center/Insurance Information Institute, 110 William St., New York, NY, 10038. (212) 669-9200


Vanity Medicine: Hope, Hype and Risk
Bergal, Jenni

A collection of articles written by the staff of the Fort Lauderdale Sun-Sentinel on cosmetic surgery. Includes articles on deceptive coding to obtain insurance coverage. Number of pages: 100+. 12/12/99

Keywords: Health insurance

Other information: Contact: Sun-Sentinel, 200 East Olas Blvd., Fort Lauderdale, FL, 33301-2293, (954) 356-4592.


Ethical Uses of Information in Insurance
Brown, Daniel J.; Gammil, Linda; Nielson, Norma L. and Seville, Mary Alice

A legal and regulatory overview of privacy legislation and issues, with particular attention to the ethics of using personal information in an insurance context. Number of pages: 76. 1/1/97

Keywords: Legal/judicial

Other information: Contact: Karen Burger, Insurance Institute for Applied Ethics, 720 Providence Rd. Malver, PA 19355-0716; phone (610) 644-2100, ext. 7805; fax (610) 644-7629; burgerK@cpcuiia.org


Fighting Fraud: The Benefits and Risks of Fraud Investigations*
Brunner, Thomas W. and Nahra, Kirk J.

Paper delivered to AISG conference. Describes various ways companies can conduct fraud investigations and use existing legal protections from tort liability. Number of pages: 17. 5/8/94

Keywords: Immunity/bad faith


Fighting Health Care Fraud
Brunner, Thomas W. and Nahra, Kirk J.

Brief overview of relevant legislation, how to conduct investigations, recover restitution, and protect from risks such as malicious prosecution. Number of pages: 31. 5/1/93

Keywords: Health insurance

Other information: Contact: Wiley, Rein and Fielding, 1776 K St. N.W., Washington, D.C. 20006; telephone (202) 429-7000.


Special Investigative Units*
Canadian Coalition Against Insurance Fraud

Means and methods of SIUs, including the role of an SIU and discussions of organizational requirements, structure and effectiveness. Number of pages: 47. 8/1/95

Keywords: SIUs/industry activities

Other information: Canadian Coalition Against Insurance Fraud, 181 University Ave. 13th Floor, Toronto, Ontario, Canada, M5H 3M7 416-362-4550, fax 416-362-4572


Research into Insurance Fraud*
Canadian Coalition Against Insurance Fraud

A summary of a research project designed to test the effects of different types of messages on insurance consumers in an attempt to reduce opportunity fraud. Number of pages: 6. 7/21/99

Keywords: Public opinion

Other information: Contact: Insurance Bureau of Canada, 500 Sherbrooke St. West, Suite 600, Montreal, Quebec, Canada, H3A 3C6 (614) 288-1563, fax (514) 288-4100


Damned If You Do and Damned If You Don't: Liabilities for Reporting Fraud (or Not)
Carpenter, Sheila J. and Meisner, Derek M.

Paper delivered to meeting of the International Association of Insurance Fraud Agencies. Reviews bad faith legislation and causes of action under immunity laws. Number of pages: 20.

Keywords: Immunity/bad faith

Other information: Contact: Jorden Burt Berenson & Johnson LLP, 1025 Thomas Jefferson St. NW, Suite 400E, Washington, D.C., 20007-0805, phone (202) 965-8100


Insurance Fraud and the Industry Response
Carris, Richard, CPCU, and Colin, Michael A., CPCU

An overview on the property and casualty industry's activities to combat fraud, extensively footnoted. Number of pages: 12. 6/1/97

Keywords: SIUs/industry activities

Other information: CPCU Society, Member Services Center, P.O. Box 3009, Malvern, PA 19355-0709, (800) 932-2728


The Costs of Excess Medical Claims for Automobile Personal Injuries*
Carroll, Stephen, et.al.

Rand Institute for Civil Justice closed-claim study linking rising costs of bodily injury claims to fraud. Estimates 35-42 percent of medical costs are excessive. Number of pages: 25. 4/1/95

Keywords: Auto insurance


Report of Accomplishments, 1995-98
Chuck Quackenbush

Report of the California insurance commissioner includes chapter on anti-fraud activities. Number of pages: 52. 11/1/99

Keywords: Legislation/regulation

Other information: Contact: Department of Insurance, 300 Capitol Mall, Suite 1500, Sacramento, CA 95814 (916) 445-5544.


Medicare Fraud: The Symptoms and The Cure
Citizens Against Government Waste

Overview of Medicare, recent laws designed to combat fraud, and sample cases. Calls for Medicare reform into market-driven system, out of government. Number of pages: 28.

Keywords: Health insurance

Other information: Contact: CAGW, 1301 Connecticut Ave. NW, Suite 400, Washington, D.C. 20036. Phone (202) 467-5300. www.cagw.org.


Combating Health Insurance Fraud
CNA

An overview of health care fraud, including estimates, state legislation and industry initiatives. Number of pages: 11.

Keywords: Health insurance

Other information: Contact: Diane Zilius, CNA, CNA Plaza-34s, Chicago, IL 60685; diane.zilius@cna.com


Focus on Insurance Fraud: An Issues Roundtable*
Coalition Against Insurance Fraud

A summary of a Coalition-sponsored discussion of fraud and potential solutions. Includes statements from industry, law enforcement, prosecutors, academic experts and consumer representatives. Participants and contact list included. Number of pages: 23. 10/7/93

Keywords: General


State Regulatory Requirements for Anti-Fraud Activities*
Coalition Against Insurance Fraud

Summary listing those activities such as fraud plans that are required by various states. Number of pages: 17. 12/1/95

Keywords: Legislation/regulation


A Statistical Study of State Insurance Fraud Bureaus*
Coalition Against Insurance Fraud

A compilation of statistics including size, budgets, referrals, convictions and other information about insurance fraud bureaus. Offers comparison with earlier data and a list of fraud bureaus. Number of pages: 23. 1/1/98

Keywords: General

Other information: Contact the Coalition for copies.


Four Faces: Why Some Americans Do-and Do Not-Tolerate Insurance Fraud*
Coalition Against Insurance Fraud

The attempt to assess why Americans are so tolerant of insurance fraud. Includes a series of recommendations designed to change attitudes. Number of pages: 40. 10/1/97

Keywords: Public opinion

Other information: Contact the Coalition.


Study of Fraudulent workers compensation Claims*
Coble, Richard J., et. al.

Extensive look at the types of schemes in workers compensation fraud and a survey about anti-fraud activity among contractors. Makes recommendations for actions to take, though somewhat dated. Number of pages: 215. 7/1/94

Keywords: Workers compensation


Guide to Fraud Awareness
Collision Industry Conference

Focuses on auto fraud opportunities in body shops. Number of pages: 9. 1/1/96

Keywords: Auto insurance

Other information: Contact: (509) 547-3810.


An Empirical Analysis of the Nature and Cost of Fraudulent Life Insurance Claims
Colquitt, L. Lee and Hoyt, Robert E.

An analysis of claiming behavior and public tolerance for insurance fraud, focusing on the life insurance industry and fraudulent death benefits. Contains information suggesting certain company practices and geographic location are linked to higher fraudulent claims. Number of pages: 29. 6/1/97

Keywords: Life insurance

Other information: Contact: National Association of Insurance Commissioners, 120 W. 12th Street — #1100, Kansas City, MO, 64105. Phone 816-842-3600


Auto Insurance Fraud: An Analysis of the Effectiveness of Anti-Fraud Programs*
Cooper, Mark

Attempts to measure effectiveness of programs and legislation to combat auto insurance fraud. Focuses on state efforts such as inspection programs to reduce auto theft. Number of pages: 12. 6/1/93

Keywords: Auto insurance

Other information: Publisher: Coalition Against Insurance Fraud


The "E-Sign" Act: Understanding Its Four Key Provisions
Crocker, Thomas E.

The E-Sign Act is a landmark legislation that for the first time give recognition and effect to electronic signatures, contracts and records. The article examines four keys elements of the E-Sign Act. Number of pages: 32. 1/1/2001

Keywords: SIUs/industry activities
Legislation/regulation

Other information: Washington Legal Foundation — http://www.wlf.org


Moral Hazard in Insurance Claiming
Cummins, J. David and Tennyson, Sharon

Examines data from the Insurance Research Council PAM studies. Concludes there is a connection between attitudes about fraud and claims behavior. Number of pages: 21.

Keywords: Public opinion

Other information: Contact: Kluwer Academic Publishers, 101 Philip Dr., Assinippi Park, Norwell, MA 02061


How to Help Stop Medicare from Being Ripped Off*
Department of Health and Human Services

A brief explanation of health fraud schemes, signs of fraud, where and how to report fraud, and other consumer-oriented information. Number of pages: 10. 1/1/93

Keywords: Health insurance


65 Concrete Steps to Fight Health Care Waste, Fraud and Abuse *
Department of Health and Human Services

HHS summary of anti-fraud provisions in the 1996 HIPAA and 1997 BBA legislation. Number of pages: 9. 1/1/98

Keywords: Health insurance


Report of the Illinois Insurance Fraud taskforce
Department of Insurance, Springfield (Illinois)

Sites members, statutory authority and recommendations on fraud reporting and whistle blower statutes of the Illinois Department of Insurance. Number of pages: 25. 10/1/2000

Keywords: Legislation/regulation
SIUs/industry activities

Other information: Contact: Illinois Department of Insurance; 320 West Washington Street, 4th Floor; Springfield, IL 62767-0001; Phone- 217-785-0116; Fax — 217-524-6500


Prosecution Outcomes 1991-1999
Derrig, Richard A., VP — Research

Statistical summary of prosecution outcomes in Massachusetts, 1991-1999 Number of pages: 37. 4-19-2000

Keywords: Prosecution


The Insufferable $23 Billion Property/Casualty Claims Process
Deutsche Banc

Over 35 technology vendors focused on software/automation, fraud/analytics, data management and portal/information are helping this vast industry improve claims efficiency and improve indemnity payment strategies Number of pages: 19. 7/5/2000

Keywords: SIUs/industry activities

Other information: Contact: Gary R. Craft, CFA ,(+1)415-617-3269, gary.r.craft@db.com
Matthew F. Kelly, (+1)415-617-3344, matthew.f.kelly@db.com


Premium Fraud
Donna J. Zak

Paper presented to AISG conference. Includes types of premium scams, indicators and discussion of documenting and audit trails Number of pages: 23. 4/21/97

Keywords: Workers compensation

Other information: Contact: Reiswig & Company, 4025 Woodland Park Blvd, Suite 210, Arlington, TX 76013, Phone: (817) 265-8898, fax (817) 860-7746.


Legal Concerns Regarding Sharing of Information: Why Not Share?
Douglas G. Houser and Linda M. Boulan

Paper delivered to AISG conference. Reviews statutes, regulation and common law re: immunity, sharing information with law enforcement or company-to-company, anti-trust and medical records statutes, as well as privacy concerns. Number of pages: 23. 4/21/97

Keywords: Immunity/bad faith

Other information: Contact: Bullivant, Houser, Bailey, Pendergrass & Hoffman, 300 Pioneer Tower, 888 SW fifth Ave., Portland, OR 97204. Phone (503) 228-6351.


Testimony of the NAIC before the U.S. House Subcommittee on Employer-Employee Relations, Committee on Economic and Educational Opportunities, U.S. House of Representatives*
Douglass, Lee

NAIC president's testimony on H.R. 995 and 996, 104th Congress. Notable for discussion of loosening regulation of MEWAs and other ERISA plans and possibly increasing fraud. Number of pages: 24. 3/28/95

Keywords: Legislation/regulation

Other information: Douglass is commissioner of the Arkansas Department of Insurance


Insurance Company Insolvency Study*
Economic Crimes Unit, FBI

A study linking insolvency and insurance fraud. Identifies 12 common fraud schemes and how they exploit regulatory weaknesses. A section on referrals and prosecution notes lack of reporting and disincentives for regulators and legitimate insurers. Number of pages: 60. 4/1/91

Keywords: Insurer fraud


Insurance Adjusters and Plaintiff's Attorneys: From Claims Fraud Consensus to Settlement Reform
Emerson, Robert W.

Reprint of legal review article shows some areas of consensus for tort reform between claims personnel and plaintiff's attorneys. Suggests routes to reducing high transaction costs in claims settlement process while rooting out fraudulent claims. Number of pages: 20. 2/1/93

Keywords: Legal/judicial

Other information: Contact: Academy of Legal Studies in Business


Insurance Claims Fraud Problems and Remedies
Emerson, Robert W.

Well footnoted research document discussing the legal environment of auto insurance fraud in the U.S., its causes and potential solutions. Discusses public attitudes, inflated claims, false claims and insurer and legislative responses. Number of pages: 67. 3/1/92

Keywords: Auto insurance

Other information: Copies may be purchased from University of Miami School of Law


Insurance Fraud: Property/Casualty Fraud Schemes and Investigative Techniques*
FBI

Overview of property/casualty fraud using the metaphor of costs of hurricanes and other natural disasters. Summarizes some suggested solutions such as SIUs and the agenda of the Coalition Against Insurance Fraud. Number of pages: 15. 1/1/95

Keywords: General


Money Laundering: A Guide for Insurance Companies*
FBI

An introduction to the basics of money laundering, including applicable legislation. Gives warning signs of suspicious transactions. Includes FBI field office phone numbers. Number of pages: 10. 3/17/93

Keywords: Insurer fraud


Insurance Fraud: Surety Bond Authenticity Guide*
FBI & Surety Assn. of America

A guide to obligees who may want to verify the authenticity of surety bonds that they are being asked to accept, plus a list of surety companies, who they are and how to find out about them. Number of pages: 10. 1/1/93

Keywords: Investigation


Health Care Fraud*
Federal Bureau of Investigation

An FBI report of resources committed to health fraud investigations, the types of crimes, and current laws under which cases are prosecuted. Contains FBI proposals for new federal laws and outlines the resources the department believes are needed. Number of pages: 18. 1/1/95

Keywords: Health insurance


Hearing I: Health Care Fraud — Who Are the Victims?
Fisher, Mike

proceedings from NAAG's hearing on health care fraud and elder abuse Number of pages: 138. 10/9/98

Keywords: Health insurance

Other information: Contact: National Association of Attorneys General, 750 First Street, N.E.,
Suite 1100, Washington, D.C. 20002; (202) 326-6000 (phone), (202)408-7014 (fax); http://www.naag.org


Insurance Issues Update: Insurance Fraud
Gastel, Ruth

Brief summary of property/casualty, workers comp, and health care fraud. Includes sections on scope, public attitudes, state legislation, model bills and industry efforts to combat fraud. Number of pages: 12. 9/1/94

Keywords: General

Other information: Contact: Insurance Information Institute, 110 William St., New York, NY, 10038. (212) 669-9200


Health Care: Fraud Schemes Committed by Career Criminals. . . *
General Accounting Office

A study of the level of involvement of organized crime in health care fraud, commissioned by the Senate's Permanent Subcommittee on Investigations. Number of pages: 17. 10/5/99

Keywords: Health insurance


N/A
General Reinsurance Corporation

It is generally accepted that at least 10 percent of all property and casualty claims paid are fraudulent, at an annual cost of $20 billion! General Reinsurance Corporation believes that employing the "best practices" in the control and deterence of insurance fraud can favorabley impact your bottom line by reducing your exposure to this problem. Number of pages: 56.

Keywords: Legislation/regulation
Legal/judicial

Other information: Contact: General Reinsurance Corporation
Home Office — Financial Centre, 695 East Main Street, P.O. Box 10350, Stamford, CT 06904-2350, Tel: 203-328-5000, Internet: www.genre.com


General Re's Guide on Insurance Fraud
General Reinsurance Corporation

This book is intended to provide individuals involved in claims investigations with general guidance on how to better detect, defeat and deter fraudulent claims. Number of pages: 58.

Keywords: Legislation/regulation
Health insurance
Auto insurance

Other information: Contact: Lewis Palca — 203-328-5438, lpalca@genre.com or Roger Cornwell — 203-328-5876, rcornwel@genre.com. Fax: 203-328-6420


Fraud and Abuse: Providers Target Medicare Patients in Nursing Facilities*
Government Accounting Office

Investigation into fraud among providers who take advantage of Medicare patients, many of them unable to make their own decisions regarding care. Suggest changes in reimbursement system. Number of pages: 29. 1/1/96

Keywords: Health insurance

Other information: Report to U.S. Rep. John Dingell, ranking minority member, Committee on Commerce.


Health Insurance: Vulnerable Payers Lose Billions to Fraud and Abuse*
Government Accounting Office

Seminal report on health care fraud, an overview of the types of fraud, and recommendations for solutions. Number of pages: 34. 5/1/92

Keywords: Health insurance


U.S. Arson Trends and Patterns-1992*
Hall, John R. Jr.

A study of types of arson and who commits it as well as general trends. Number of pages: 56. 10/1/93

Keywords: Arson for profit


Waiving the Right to Demand Proof of Loss
Hammond, Rick

An analysis of court decisions examining insurer conduct which causes the waiver of the right to demand a proof of loss, normally considered a clause in policies designed to protect insurers. Number of pages: 5. 9/1/96

Keywords: Legal/judicial

Other information: Contact the Illinois Association of Defense Trial Counsel


HIAA's View of Health Care Fraud*
Health Insurance Association of America

Testimony given by Bill Gradison before Senate Special Committee on Aging in hearing on health care fraud. Includes a Sept. 1994 survey report from HIAA of its members' anti-fraud programs. Number of pages: 30. 3/21/94

Keywords: Health insurance

Other information: Kathleen Fyffe was lead author of survey report.


Health Insurance Fraud: The Scope of the Problem...And Some Solutions*
Health Insurance Tracking Unit, Ætna Life & Casualty

A brief overview of health care fraud, Ætna's anti-fraud activities and suggestions of what companies and consumers can do to help fight fraud. Somewhat dated. Number of pages: 12. 9/1/92

Keywords: Health insurance


Effects of Antifraud Laws: Analysis Using the New NCCI Econometric Model
Helvacian, N. Mike and Dan Corro

Review of the statutes that regulate workers comp insurance and focus on the effects of fraud prevention measures on the claim frequencies, average claim costs, and system costs per worker. Number of pages: 6.

Keywords: Legislation/regulation
Workers compensation

Other information: Contact: NCCI, 750 Park of Commerce Drive, Boca Raton, FL 33487; 1-800-NCCI-1-2-3. Website: www.ncci.com


State Medical Boards and Medical Discipline*
HHS Office of Inspector General

Study of trends in disciplinary actions taken against medical providers by state licensing boards. Concentrates on malpractice. Number of pages: 41. 8/1/90

Keywords: Health insurance


Auto Injuries: Claiming Behavior and Its Impact on Insurance Costs
Insurance Research Council

Executive summary of closed-claim study showing BI claims increasing, especially for soft-tissue injuries, as property claims declined. Links attorney involvement with cost of claim, notes regional disparities in rate of injury. Number of pages: 12. 4/1/95

Keywords: Auto insurance

Other information: Contact: IRC, 211 S. Wheaton Ave., Suite 410, Wheaton, IL 60178, phone (708) 871-0255


Fighting Fraud in the Insurance Industry*
Insurance Research Council

"Snapshot in time" of survey conducted of industry and state government efforts to combat fraud. Focuses on SIUs and state fraud bureaus. Extensive tables. Number of pages: 35. 10/1/92

Keywords: General

Other information: Contact: IRC, 211 S. Wheaton Ave., Suite 410, Wheaton, IL 60178, phone (708) 871-0255


Public Attitude Monitor 1995
Insurance Research Council

Survey of attitudes towards claims buildup to make up for premiums or deductibles makes up one chapter of the report. Number of pages: 5. 11/1/95

Keywords: Public opinion

Other information: IRC, 211 S. Wheaton Ave., Suite 410, Wheaton, IL 60187, phone (708) 871-0255


Reference Guide to Historical PAM Questions
Insurance Research Council

Contains all question asked in surveys from 1980-95 including those about attitudes toward claims fraud. Number of pages: 75. 11/1/95

Keywords: Public opinion

Other information: IRC, 211 S. Wheaton Ave., Suite 410, Wheaton, IL 60187, phone (708) 871-0255


Trends in Auto Injury Claims, Part Two: Analysis of Claims Costs
Insurance Research Council

Demonstrates disparities in cost of claims based on geographic breakdowns and by types of coverage. Number of pages: 29. 12/1/95

Keywords: Auto insurance

Other information: Contact: IRC, 211 S. Wheaton Ave., Suite 410, Wheaton, IL 60178, phone (708) 871-0255


Fraud and Buildup in Auto Injury Claims
Insurance Research Council

A multistate study of auto injury claims that led to a conclusion that about 36 percent of those claims had signs of fraud or buildup Number of pages: 107.

Keywords: Auto insurance

Other information: Contact: IRC, 211 S. Wheaton Ave., Suite 410, Wheaton, IL 60187. Phone (630) 871-0255, fax (630) 871-0260


Public Attitude Monitor
Insurance Research Council

Annual survey on level of public tolerance for fraud committed to cover premiums or deductibles. Number of pages: 20. 12/1/97

Keywords: Public opinion

Other information: Contact: Insurance Research Council, 211 S. Wheaton Ave., Suite 410, Wheaton, IL 60187. Phone (630) 871-0255; fax (630)871-0260, www.ircweb.org


Fighting Fraud in the Insurance Industry
Insurance Research Council

Second survey of company efforts and resources put into fighting fraud, as well as a look at what companies intend to do in the future. Number of pages: 72. 10/1/97

Keywords: SIUs/industry activities

Other information: Contact: Insurance Research Council, 211 S. Wheaton Ave., Suite 410, Wheaton, IL 60187. Phone (630) 871-0255; fax (630)871-0260, www.ircweb.org


Public Attitude Monitor 1998-Choice in Auto Insurance
Insurance Research Council

Survey of attitudes toward no-fault insurance and managed auto repair. Number of pages: 23. 10/1/98

Keywords: Auto insurance

Other information: Contact: IRC, 718 Providence Rd., P.O. Box 3025, Malvern, PA 19355-0725, www.irc.org.


Paying for Auto Injuries
Insurance Research Council

A wide survey of consumers and their experiences in settling auto injury claims. Correlates attorney involvement with levels of satisfaction and concludes that claimants who hire attorneys are less satisfied with the net amount received. Number of pages: 111. 10/1/99

Keywords: Public opinion

Other information: Contact: IRC, 718 Providence Rd., P.O. Box 3025, Malvern, PA 19355-0725, www.irc.org.


Public Attitude Monitor-Vehicle Theft
Insurance Research Council

A survey of attitudes toward auto theft, effectiveness of anti-theft devices and rate of ownership of those devices. Number of pages: 31. 10/1/99

Keywords: Auto insurance

Other information: Contact: IRC, 718 Providence Rd., P.O. Box 3025, Malvern, PA 19355-0725, www.irc.org.


Public Attitude Monitor 1999
Insurance Research Council

Survey that indicates many Americans believe that workers comp fraud is widespread and increasing. Also includes data on acceptability of various forms of WC fraud. Number of pages: 23. 7/1/99

Keywords: Workers compensation

Other information: Contact; IRC, 718 Providence Rd., P.O. Box 3025, Malvern, PA 19355-0725, (610) 644-2212, fax (610) 640-5388, www.ircweb.org


Public Attitude Monitor 2000
Insurance Research Council

Examines Americans opinions about class action suits and explores public attitudes about allowing third party bad faith lawsuits. Also updates previous IRC studies regarding the public's acceptance of claims padding. Number of pages: 27. 6/1/2000

Keywords: Legal/judicial

Other information: Contact: IRC, 718 Providence Road, P.O. Box 3025, Malvern, PA 19355-0725, telephone 610.644.2212, fax 610.640.5388, internet www.ircweb.org.


Public Attitude Monitor 2000
Insurance Research Council

Examines the public's opinion about cellular phones and driving, large trucks and highway safety, and household ownership of vehicles that are uninsured. Number of pages: 31. 12/1/2000

Keywords: Auto insurance

Other information: Contact: IRC, 718 Providence Road, P.O. Box 3025, Malvern, PA 19335-0725; phone: 610-644-2212; fax: 610-640-5388; internet: www.ircweb.org


Building on Common Ground*
International Association of Special Investigation Units

The proceedings of a two-day fraud forum held to review progress and suggest future direction for the fight against fraud. Includes sections on public awareness, legislation and regulation, industry responses and effective prosecutions. Number of pages: 59. 5/10/95

Keywords: General


1995 ICA Fraud Survey*
International Claim Association Fraud Committee

A fairly simple company survey of anti-fraud activities, focusing on SIU issues such as size, location, number of investigations, etc. Number of pages: 8. 5/1/95

Keywords: SIUs/industry activities


Financial Crime's Project Second Health Care Round Table
Jones, Sarah Elizabeth

Report on a panel sponsored by the National Association of Attorneys General. Topics include laws, managed care issues, privacy and technology issues and identifying fraud. Number of pages: 11.

Keywords: Health insurance

Other information: Contact: Financial Crimes Project Assistant, NAAG, (202) 326-6057.


Health Care Fraud in a Managed Care Environment
Judd, Thomas R. and Jones, Sarah Elizabeth

An examination of the issues surrounding managed care and the transition to those systems and how they might be vulnerable to health care fraud schemes. Includes appendix of state-by-state activities permitted to investigate fraud. Number of pages: 65. 1/1/96

Keywords: Health insurance

Other information: The authors are staff members of the National Assn. of Attorneys General. Contact: NAAG, 444 N. Capitol St., Washington, D.C. 20001. (202) 434-8060


The States' Response to Health Care Fraud
Judd, Thomas R. and Jones, Sarah Elizabeth

A review of methods successfully used in certain states to combat health care fraud. The monograph, published by the National Association of Attorneys General, is intended for attorneys general who want to become active in this arena. Number of pages: 59. 6/1/98

Keywords: Health insurance

Other information: Copies of the report are $25. Contact NAAG, 750 First St., NE, Washington, D.C. 20002, phone (202) 326-6057, fax (202) 408-7014.


How Health Care Fraud Affects Employers-And What Can Be Done About It
Kirk J. Nahra

An overview of the various types of scams affecting employers with health coverage, including fraud in managed care systems. Also reviews current legislation and the strengths and weaknesses of various ways of fighting fraud. Number of pages: 24. 1/1/96

Keywords: Health insurance


Auto Theft in New York
Long Island Chapter, CPCU

Overview of theft problem, costs, legislation, and other antitheft activities in New York Number of pages: 98. 5/17/93

Keywords: Auto insurance

Other information: Long Island Chapter of CPCU, 377 Oak St., Garden City, NY 11530-0601


Testimony*
Mahon, William J.

Testimony before two subcommittees of the committee on Government Operations, U.S. House of Representatives. Gives overview of problem and calls for additional legislation protecting private payers Number of pages: 9. 3/17/94

Keywords: Health insurance

Other information: Contact: National Health Care Anti-Fraud Association, 1255 23rd St. NW, Washington, D.C., 20037-1174; telephone (202) 659-5955, fax (202) 833-3636.


Criminal Prosecution or Civil Lawsuit: The Dilemma of Workers' Compensation Premium Fraud Proceedings
Mark A. Kirsch

An examination of the pros and cons of proceeding with a civil suit concurrent with a criminal prosecution. Number of pages: 5. 1/1/97

Keywords: Workers compensation

Other information: NCCI, 750 Park of Commerce Dr., Boca Raton, FL 33487. Phone 561-997-1000, fax 561-997-4233. Web: http://www.ncci.com


Protecting with Distinction*
Martin T. Biegelman

A history of the mail fraud statute by the U.S. Postal Inspection Service Number of pages: 28. 6/1/99

Keywords: Legislation/regulation

Other information: website: www.usps.gov/postalinspectors


The Impact of Special Investigation Units on Insurance Fraud*
Matysiak, Richard J.

Brief overview of SIU history and purpose. Discusses key components of an effective SIU and model legislation provision related to SIUs, including mandatory reporting, immunity, etc. Examples drawn from author's experience. Number of pages: 21. 1/1/94

Keywords: SIUs/industry activities

Other information: Author was senior fraud investigator in Georgia Department of Insurance.


California Workers Compensation Institute Referral Report
Miller, Mark

Summary of the Institute's fraud referral survey for second quarter, 1999. Number of pages: 16. 11/10/99

Keywords: Workers compensation

Other information: Contact: CWCI, 1111 Broadway, Suite 2350, Oakland, CA (510) 663-1063, Fax (510) 663-1064, www.cwci.org


Insurance Fraud Project: Report on Research*
Mooney, S.F. and Salvatore, J.M.

Defines fraud and attempts to estimate scope. Summarizes state legislation as well as roles of tools such as databases, SIUs and other ways to fight fraud. Includes text of model legislation on fraud bureaus, immunity, etc. Number of pages: 20. 11/1/90

Keywords: General

Other information: Publisher: Insurance Information Institute, 110 William St., New York, NY, 10038. (212) 669-9200


Health Insurer's Anti-Fraud Programs
Musco, Thomas D., Fyffe, Kathleen and Pohlman, Shannon

An extensive survey of the health industry's activities, including types of cases, dollars spent on anti-fraud programs, and dollars saved. Number of pages: 21.

Keywords: SIUs/industry activities

Other information: Contact Fulfillment Office, HIAA, 555 13th St. NW, Suite 600 East, Washington, D.C. 20004-1109.


Testimony of the National Association of Insurance Commissioners before the Committee on Labor and Human Resources of the U.S. Senate *
Musser, Josephine

NAIC recording secretary's testimony in 104th Congress. Notable for discussion of consumer complaints about MEWAs and other ERISA plans and need to increase regulation. Number of pages: 23. 3/15/95

Keywords: Legislation/regulation

Other information: Musser is commissioner of insurance in Wisconsin.


Statement before the Senate Committee on Labor and Human Resources*
Nadel, Mark V.

GAO testimony based on their investigations into ERISA and MEWAs. Number of pages: 7. 7/25/95

Keywords: Legislation/regulation

Other information: Nadel is Associate Director for National and Public Health Issues, Health, Education and Human Services Division.


Recovering the Proceeds of Health Care Fraud
Nahra, Kirk J.

Review of laws and cases governing restitution and recovery. Suggests strategies for indictments, information, plea bargaining and proving restitution. Number of pages: 25. 11/1/94

Keywords: Health insurance

Other information: Contact: Wiley, Rein and Fielding, 1776 K St. N.W., Washington, D.C. 20006; telephone (202) 429-7000.


Reducing Insurer Liability for Conducting Fraud Investigations
Nahra, Kirk J.

Article reprint reviews potential for tort liability in absence of reasonable guidelines for fraud investigations. Reviews several state immunity statutes. Emphasizes importance of acting in good faith to minimize risk. Number of pages: 30. 3/1/95

Keywords: Immunity/bad faith

Other information: Contact: FICC Quarterly Editorial Office, Marquette U. Law School, 1103 W. Wisconsin


Restitution as a New Weapon for Recovering the Proceeds of Fraud
Nahra, Kirk J.

Reprint of legal review article dealing with restitution. Urges corporate victims to get involved early in plea-bargaining, when issue is incorporated most effectively. Number of pages: 15. 4/1/93

Keywords: Restitution

Other information: Contact: FICC Quarterly Editorial Office, Marquette U. Law School, 1103 W. Wisconsin Ave., Milwaukee, WI 53233. Phone (414) 288-7095, fax (414) 288-5914


The Role of Victims in Criminal Investigations and Prosecutions*
Nahra, Kirk J.

A white paper commissioned by the Coalition to examine the implications of People vs. Eubanks, a California Supreme Court decision that could affect assistance insurers provide to anti-fraud investigations and prosecutions Number of pages: 17. 1/1/98

Keywords: Legal/judicial

Other information: Contact the Coalition for copies.


Fighting Fraud in a Managed Care Environment
Nahra, Kirk J.

Suggests that fraud is not eliminated in managed care environments, but that the schemes simply change. Gives examples of the potential for fraud. Number of pages: 5. 1/1/98

Keywords: Workers compensation

Other information: Contact: NCCI, 750 Park of Commerce Dr., Boca Raton, FL 33487 (561) 997-1000, fax ( 561) 997-4233, http://www.ncci.com


New Opportunities and Risks in Working with Law Enforcement
Nahra, Kirk J.

An examination of the portions of the Health Insurance Portability and Accountability Act that require insurers to work with goverment in heatlhcare fraud. Has implications for p/c insurers as well on any claims that involve a health care provider Number of pages: 42. 6/1/99

Keywords: Legislation/regulation

Other information: Contact: Kirk J. Nahra, Wiley, Rein and Fielding, 1776 K Street NW, Washington, D.C. 20006 Phone (202) 719-7000 Fax (202) 719-7049


Industry Legal Concerns In Providing Information Relating to Insurance Fraud Investigations
Nahra, Kirk J.

Overview of the issues necessary to allow investigators to focus attention on legally significant facts, conduct investigations within legal boundaries, work effectively with law enforcement and attorneys, and avoid inappropriate investigative techniques. Number of pages: 43.

Keywords: SIUs/industry activities
Investigation
Legal/judicial

Other information: Contact: Kirk J. Nahra, Wiley, Rein & Fielding, 1776 K Street NW, Washington, DC 20006; phone: 202-719-7335; fax: 202-719-7049; e-mail: KNahra@WRF.com


Antifraud taskforce Report 2000
NAII

Legislative and regulatory actions against fraud in the states Number of pages: 75. 2-17-2000

Keywords: SIUs/industry activities

Other information: Contact: NAII, 2600 River Road, Des Plaines, IL 60018. Phone: 847-297-7800, Fax: 847-297-5064, www.naii.org


Health Care Fraud-Who are the Victims?
National Association of Attorneys General

Proceedings of a hearing held at the behest of a NAAG initiative on health care fraud and elder abuse. Panelists included representatives of the Coalition, the National Health Care Anti-Fraud Association, and attorney generals. Includes a directory of state and federal contacts. Number of pages: 84. 10/9/98

Keywords: Health insurance

Other information: Contact: Traci J. Sanders, NAAG, 750 First St., NE, Suite 1100, Washington, D.C. 20002. Phone: (202) 326-6000, fax (202) 408-7014. www.naag.org.


The Cost Impact of workers compensation Insurance on an Average Home*
National Association of Home Builders

State-by-state analysis concludes workers comp insurance adds $4,370 to the cost of building an average home. Ranks states high to low. Many charts of wage and premium data. Number of pages: 13. 9/1/93

Keywords: Workers compensation


ERISA: A Call for Reform
National Association of Insurance Commissioners

NAIC white paper w/overview of ERISA. Focus is on consumer complaints and lack of remedies. Calls for increased consumer protections and additional regulation. Number of pages: 21. 6/1/94

Keywords: Legislation/regulation

Other information: Contact NAIC for permission to reproduce.


Guidelines for State Insurance Regulators to the Violent Crime Control and Law Enforcement Act of 1994
National Association of Insurance Commissioners

NAIC's recommendations to insurers for dealing with that part of the criminal code that bars convicted felons from participating in the insurance industry. Number of pages: 65. 3/1/98

Keywords: Legislation/regulation

Other information: Contact: NAIC, 120 West Twelfth St., Kansas City, MO 64105. Phone (816) 842-3600 www.naic.org.


Medicaid Fraud and Patient Abuse
National Association of Medicaid Fraud Control Units

A study of the various forms of schemes perpetrated against the Medicaid system, including current trends. Discusses patient abuse cases involving sexual, physical or financial abuse. Includes contacts for all state units. Number of pages: 83+.

Keywords: Health insurance

Other information: Contact: NAMFCU, 444 N. Capitol St., Suite 339, Washington, D.C. 20001


Fall Issues Report
National Council on Compensation Insurance

Analysis of workers compensation market that includes articles on the effectiveness of anti-fraud legislation and a Coalition study of workers compensation outreach material. Number of pages: 27. 12/1/99

Keywords: Workers compensation

Other information: Contact: NCCI, 750 Park of Commerce Dr., Boca Raton, FL 33487, fax (954) 236-8346, www.ncci.com.


1999 Workers Compensation Mid-Year Issues Report
National Council on Compensation Insurance, Inc.

Mid-year review that updates year-end result for 1998, including new accident year estimates. Number of pages: 25.

Keywords: Workers compensation
Legislation/regulation

Other information: Contact: NCCI, 750 Park of Commerce Drive, Boca Raton, FL 33487
800-NCCI 1-2-3; website: www.ncci.com


Model Guidelines for the Sharing of Health Care Fraud Information between Law Enforcement and Private Payers*
National Health Care Anti-Fraud Association

Copies of the NHCA guidelines as well as those issued by the
Department of Justice, with commentary Number of pages: 18. 10/1/98

Keywords: Health insurance

Other information: NCHAA, (202) 659-5955


Recommended Insurance Fraud Prevention Guidelines
National Insurance Crime Bureau

NICB's recommendations for a model insurance company anti-fraud program. Number of pages: 38. 6/1/95

Keywords: Legislation/regulation

Other information: Contact: NICB, 10330 S. Roberts Rd., Palos Hills, IL 60465. Phone (708) 430-2430, ext. 315.


The Faces of Fraud
National Insurance Crime Bureau

Insurance fraud has many faces. Legislators, prosecutors and consumers have joined forces with insurance companies, law enforcement agencies, self-insured companies, vehicle manufacturers and the National Insurance Crime Bureau. Number of pages: 29.

Keywords: Legislation/regulation
SIUs/industry activities

Other information: Contact: Steven M. Rudner, Vice President - Communications
National Insurance Crime Bureau, 10330 South Roberts Road, Palos Hills, IL 60465, 708-430-2430.


Insurance Fraud: The Recurring Catastrophe*
Nationwide Insurance

Overview of property/casualty fraud using the metaphor of costs of hurricanes and other natural disasters. Summarizes some suggested solutions such as SIUs and the agenda of the Coalition Against Insurance Fraud. Number of pages: 20. 6/1/94

Keywords: General

Other information: White paper prepared by Nationwide staff.


Annual Report, Fiscal Year 1998-1999 — Florida Department of Insurance, Fraud Division
Nelson, Bill

Insurance Commissioner Bill Nelson has taken unprecedented steps in his commitment to fight insurance fraud, which has been estimated to cost Floridians $6.9 billion each year. Number of pages: 36.

Keywords: Legislation/regulation
Prosecution
Investigation
SIUs/industry activities

Other information: Contact: Bill Nelson, Treasurer/ Insurance Commissioner/ Fire Marshal, 850-922-3115; http://www.doi.state.fl.us/


Fraud in Electronic Submittal and Payment of Health Insurance Claims*
NHCAA taskforce on Fraud in Electronic Data Interchange

Executive summary of report on vulnerabilities of EDI systems to fraud, including legal issues. Number of pages: 8. 12/1/95

Keywords: Health insurance


Fraud in Managed Health Care Delivery and Payment*
NHCAA taskforce on Fraud in Managed Care

Executive summary of a taskforce report on how health care fraud is not lessened but rather changed and becomes subtler as entities move into managed care plans. Notes that such plans place new and different demands on fraud investigators. Number of pages: 5. 12/1/94

Keywords: Health insurance


Statement before the Senate Committee on Labor and Human Resources*
Nunn, Sen. Sam

Testimony before the Senate in support of the Employer Group Purchasing Reform Act of 1995, which he cosponsored. It tightens state regulation of MEWAs to cut down on fraud and abuse. Number of pages: 8. 7/25/95

Keywords: Legislation/regulation



Office of Insurance Fraud Prosecutor (New Jersey)

Detailed summary of criminal statistics for 1999 — cases opened, investigated, prosecuted and convicted. Number of pages: 51. 3/1/2000

Keywords: Prosecution


Juvenile Life Insurance: A Report on Current Practices
Office of the Insurance Commissioner

A survey of the juvenile of life insurance market and findings in the state of Washington Number of pages: 54. 12/1/2000

Keywords: Life insurance


Insurance Fraud Prevention and Control: Current Industry Practices
Ontario Insurance Commission

An overview of types of property/casualty claims fraud in the U.S. and Canada. Summarizes deterrent efforts (includes advertising samples) and industry efforts designed to detect fraud. In English and French. Number of pages: 52. 1/1/93

Keywords: General

Other information: Ontario Insurance Commission, 5160 Yonge St., 15th Floor, North York, Ontario, CN, M2N 6L9, (416) 250-7250, fax (416) 590-7070


Do Criminal Felony Sanctions Serve as a Deterrent to Insurance Fraud?
Oregon Chapter, CPCU Society

A case study on insurance fraud and related statutes in Oregon. Compares various model laws. Number of pages: 30 + appendices. 5/1/98

Keywords: Legislation/regulation

Other information: Reprints are $5. contact Julie Hansen at (800) 456-6343.


Combating Workers Compensation Fraud
Pence, Linda L.

Tips on recognizing and investigating various workers comp fraud schemes, including when to call in legal assistance. Number of pages: 7. 2/1/98

Keywords: Workers compensation

Other information: Contact: Linda L. Pence, Esq., Johnson, Smith, Pence, Densborn, Wright and Heath, One Indiana Square, Suite 1800, Indianapolis, IN 46204. Phone (317) 634-9777.


Governor's taskforce on Health Care Fraud*
Peter Verniero

Report of a New Jersey taskforce on problems and solutions in that state. Recommends additional legislation. Number of pages: 68. 12/23/96

Keywords: Legislation/regulation

Other information: Verniero is attorney general and chaired the task force.


Measuring and Monitoring Fraud in workers compensation
Quality Planning Confidential

Suggests some methodologies by which estimates of the amount of fraud can be determined. Looks at pros and cons. Number of pages: 14. 4/1/92

Keywords: Workers compensation

Other information: Corporate principals in insurance fraud are Dr. Daniel Finnegan and Dr. Gail Simpson.


How Big is the Price Tag for Excess Auto Injury Claims?
RAND Institute for Civil Justice

Abstract of larger study attempting to estimates fraud costs. Number of pages: 3. 5/1/95

Keywords: Auto insurance

Other information: RAND Institute for Civil Justice, 1700 Main St., Santa Monica, CA 90407-2138, 310-393-0411


Statement before the Senate Committee on Labor and Human Resources*
Randall, David J.

Testimony from the NAIC's State and Federal Health Insurance Legislative Policy (B) taskforce on ERISA/MEWA regulations and proposed tightening. Includes victim stories and scam examples. Number of pages: 20. 7/25/95

Keywords: Legislation/regulation

Other information: Randall is deputy director, Ohio Department of Insurance.


Comparative and Reverse Bad Faith: A Two-Way Street
Reeder, Robert R, and Minkoff, Deborah M.

Review of litigation and pleadings relevant to reverse bad faith, as well as theories available to insurers to increase chances of a recovery. Number of pages: 20. 4/21/96

Keywords: Immunity/bad faith

Other information: Contact: Cozen & O'Connor, 1900 Market St., Philadelphia, PA, 19103; telephone (215) 665-2000.


Controlling SIU Liability Exposures
Regan, Thomas M.

Review of litigation and legal theories upon which insureds sue companies for actions taken by investigators, the facts upon which the suits are built, and suggestions for avoiding similar litigation. Number of pages: 28. 4/21/96

Keywords: Immunity/bad faith

Other information: Contact: Cozen & O'Connor, 1900 Market St., Philadelphia, PA, 19103; telephone (215) 665-2000.


Affordable Auto Insurance for Urban Communities: The Universe of Possibilities*
Reiersen, John D.

Speech to the Auto Accident Compensation Project that focuses on Robert Plan and its effects in New York and New Jersey Number of pages: 19. 5/12/95

Keywords: Auto insurance

Other information: Reiersen is president, Eagle Insurance Group.


Practical Advice for Insurance Companies in Assisting with Prosecution of Insurance Fraud Crimes
Rudloff, G. Edward Jr.

Overview of state and federal laws, including immunity. Contains specific methods for packaging evidence, reporting and post-reporting cooperation with prosecutors. Number of pages: 26. 4/21/96

Keywords: Prosecution

Other information: Contact the Defense Research Institute


The Use of Private Investigators: Guidelines for Attorneys*
Seymour, et.al.

An unpublished paper delivered in a Maryland State Bar workshop. Outlines appropriate circumstances when a PI might be useful, as well as some issues of confidentiality and other ethical considerations. Number of pages: 12. 6/12/92

Keywords: Investigation


Confidentiality of Individually Identifiable Health Information*
Shalala, Donna

Secretary of HHS's proposal on behalf of the Clinton administration. Submitted to the House Commerce and Ways and Means committees, as well as the Senate's Labor and Human Resources and Finance committees. Includes summary of statutory requirements for a health care integrity and protection databank. Number of pages: ?. 9/11/97

Keywords: Legislation/regulation


Final Staff Draft Report on Health Care Claims Study and Comments from Affected State Agencies
Sharp, John

The 1997 Texas Legislature approved a measure to improve the state's efforts to combat Medicaid fraud and overpayments, and directed the Comptroller of Public Accounts to study the size and nature of fraud and overpayments in the state's health care programs. Number of pages: 249. 12/1/98

Keywords: Health insurance
Legislation/regulation

Other information: Contact: The Honorable John Sharp, Texas Comptroller of Public Accounts
L.B.J. State Office Building, 111 East 17th Street, Austin, TX 78774


The Adverse Impact of workers compensation Premium Fraud on Honest Businessmen*
Smith, J. Layne

Copy of speech outlining various ways workers comp premium fraud is committed. Reviews applicable statutes. Number of pages: 25.

Keywords: Workers compensation

Other information: Contact him at Bateman and Grahman, Attorneys at Law, 300 E. Park Ave., Tallahassee, FL 32301. Phone (904) 224-2677, fax (904) 561-6475.


Health Care Fraud Control: Understanding the Challenge
Sparrow, Malcolm K

An evaluation of the strengths and weaknesses of the assumptions, policies and systems being used to control health fraud. Argues that current systems are not geared toward stopping criminal activity. Number of pages: 10. 2/1/96

Keywords: Health insurance


License to Steal: Why Fraud Plagues America's Health Care System
Sparrow, Malcolm K.

Book on strengths and weaknesses of the assumptions, policies and systems being used to control health fraud. Argues that current systems are not geared toward stopping criminal activity. Number of pages: 234. 1/1/96

Keywords: Health insurance


Electronic Data Interchange of workers compensation Claims*
Spencer, Robert R.

Brief look at state of programs to standardize claims reporting via EDI, including IAIABC pilot projects. Number of pages: 8.

Keywords: Investigation


Industry Concerns and Compliance
Stano, Phillip

Concerns of the American Council of Life Insurance about that part of the federal criminal code that bars convicted felons from participating in the insurance industry. Number of pages: 55. 12/5/98

Keywords: Legislation/regulation

Other information: Contacta: ACLI, 1001 Pennsylvania Ave. NW, Washington, D.C. 20004. Phone (202) 624-2183


Recent Developments in Life and Health Insurance Fraud Legislation
Stano, Phillip E.

Analysis of federal fraud legislation from 1994 omnibus crime bill, NAIC and Coalition model anti-fraud bills, and appendix summarizing state anti-fraud legislative action. Paper delivered to and © by The Association of Life Insurance Counsel. Number of pages: 69. 5/22/95

Keywords: Life insurance

Other information: Contact: American Council of Life Insurance, 1001 Pennsylvania Ave. N.W., Washington, D.C. (202) 624-2183


Retrospective Premium Policies and the Emergence of a New Burden for workers compensation Insurers
Stern, Robert A.

Reprint of commentary on decisions regarding the legality of insureds' allegations of breach of covenant and good faith against carriers issuing policies containing retrospective premium clauses. Number of pages: 7. 6/1/94

Keywords: Workers compensation

Other information: Contact: Mealey's Publications Inc., 512 Lancaster Ave., Wayne, PA, 19087-0446 (215) 688-6566, fax (215) 688-7552. ISSN No. 1775-380X


The Uninsured Motorist Puzzle
Sugarman, Stephen D.

An examination of the uninsured motorist problem and "no-pay, no-play" insurance proposals. Number of pages: 12. 1/1/98

Keywords: Auto insurance

Other information: Contact: Auto Accident Compensation Project, Center for Consumer Affairs, University of Wisconsin-Milwaukee, (414) 227-3135, fax (414) 227-3267.


Insurance Fraud: The Fall from Grace
Sullivan, Gerald J.

Paper delivered to the 1994 Western Surplus Lines Conference. Reviews scam operations including Teale, Miro and Empire Blue Cross. Suggests some general ways to combat these operations. Number of pages: 12. 4/7/94

Keywords: Insurer fraud

Other information: Contact G.J. Sullivan & Associates


Testimony before the House Subcommittee on Commerce, Consumer Protection and Competitiveness*
Sumner, Daniel Y.

Testimony giving some background on a MetLife life insurance sales operation called the Nurses' Guaranteed Retirement Savings Plan uncovered in Florida. Number of pages: 8. 4/28/94

Keywords: Life insurance


The People vs. Terry Eugene Birkett*
Supreme Court of California

An opinion rendered by the court that held that insurers were not direct crime victims and thus were ineligible for restitution when they had reimbursed their insureds for crime-related losses. Number of pages: 14. 8/5/99

Keywords: Legal/judicial


Second Interim Report on Insurance Fraud in Florida in the Area of Personal Injury Protection
Supreme Court of the State of Florida

Examination and definition of personal injury protection fraud with testimony from fraud investigators, lawyers, chiropractors, accident victims and individuals involved in illegal solicitation. Number of pages: 27. 8-17-2000

Keywords: Legal/judicial
Auto insurance
Investigation


Medical Issues of Fraud and Abuse in Workers' Compensation
Taricco, Alfred, M.D.

Overview of causes and areas for fraud and abuse in workers comp claims. Includes typical examples, examined by areas of specialty. Also discusses others in claims process, such as lawyers. Number of pages: 25. 1/1/95

Keywords: Workers compensation

Other information: Contact: LRP Publications, Horsham, PA 19044. Copy permission granted with $2+$1.50/page payment to Copyright Claims Center, 27 Congress St., Salem MA 01970


Health Care Claims Study*
Texas Comptroller of Public Accounts

A study of claims against the Texas public health care system, including Medicare and Medicaid to attempt to determine the amount of fraud in the system. Concludes that the numbers the study found still underestimate the problem. Number of pages: 204. 12/1/98

Keywords: Health insurance

Other information: Contact: Texas Comptroller of Public Accounts, P.O. Box 219, Austin, TX 78767-0219, (512) 463-4000, fax (512) 463-4965


Chronology of F.T. Riley's Activities and Related Regulatory Actions*
U.S. General Accounting Office

Report to the House Subcommittee on Oversight and Investigations, Committee on Energy and Commerce. Reviews the nature and scope of insurance businesses run by Ferrell T. Riley and various state efforts to shut them down. Number of pages: 17. 10/1/94

Keywords: Insurer fraud


Employer-Based Health Plans: Issues, Trends and Challenges Posed by ERISA*
U.S. General Accounting Office

GAO study of growth in ERISA plans and problems state regulators encounter, including fraud and consumer complaints. Extensive tables include discussion of recent court decisions regarding state and federal roles regulating ERISA plans. Number of pages: 64. 7/1/95

Keywords: Legislation/regulation


Medicare: Improprieties by Contractors Comprised Medicare Program Integrity
U.S. General Accounting Office

Report of the fraud, waste and abuse of medical contractors to the Permanent Subcommittee on Investigations, Committee on Governmental Affairs. Number of pages: 31. 7/1/99

Keywords: Health insurance

Other information: Contact: U.S. General Accounting Office, P.O. Box 37050, Washington, D.C. 20013. Website: http://www.gao.gov


Health Care Fraud: Information-Sharing Proposals to Improve Enforcement Efforts*
U.S. Government Accounting Office

A study of the need for an overarching federal immunity statute as well as the need for an all-claims database. Makes no recommendations. Number of pages: 96.

Keywords: Immunity/bad faith

Other information: Report to Subcommittee on National Security, International Affairs and Criminal Justice, House Committee on Government Reform and Oversight.


Fourth Interim Report, #104-92*
U.S. Senate Permanent Subcommittee on Investigations

Investigation into government efforts to combat fraud and abuse in Blue Cross plans in WV, MD, NY, Washington D.C., and federal contracts. Includes recommendations for accountability, etc. Number of pages: 88. 6/5/95

Keywords: Legislation/regulation


Health Care Fraud: A Provider's Guide to Achieving Legal Compliance.
Weinreich, Gadi and Janney, Christopher C.

Reviews fraud schemes, enforcement tools, and compliance issues, then discusses pros and cons of voluntary disclosure of misconduct. Number of pages: 87. 1/1/97

Keywords: Legislation/regulation

Other information: Contact: Washington Legal Foundation, 2009 Massachusetts Ave. NW, Washington, D.C. 20036; phone (202) 588-0302; http://www.wlf.org


Fraud and Automobile Insurance: A Report on Bodily Injury Liability Claims in Massachusetts
Weisberg, H.I. and Derrig, R.A.

An analysis of nearly 600 bodily injury liability claims filed in Mass. 7/1/95 to 6/30/86. Attempts to sharpen distinction between buildup and outright fraud. A focus on one city helps refine fraud indicators. Number of pages: 43. 3/1/91

Keywords: Arson for profit


Insurance Fraud: workers compensation Premium Fraud*
White-Collar Crimes Sections, FBI

Introduction to basic types of premium fraud in workers comp insurance. Number of pages: 5.

Keywords: Workers compensation


Reducing Premium Fraud in the workers compensation System*
Zaidman, Brian

Report to MN legislature on types of premium fraud in workers comp system. Identifies holes in statutes and suggests legislative language. Also makes recommendations for administrative structures and changes to combat problem. Number of pages: 62. 3/1/93

Keywords: Workers compensation