Workers Compensation And The National Insurance Crime Bureau ...

I had not heard of the National Insurance Crime Bureau (NICB) until last week. The organization functions as a repository for questionable claims. The organization seems to be somewhat similar to the Index Bureau.

This is from the NICB's website - The National Insurance Crime Bureau is a not-for-profit organization that receives support from approximately 1,000 property/casualty insurance companies. The NICB partners with insurers and law enforcement agencies to facilitate the identification, detection and prosecution of insurance criminals.

The NCIB centers on questionable claims, not all claims. Questionable claims (QCs) are those claims that NICB member insurance companies submit to NICB for closer review and investigation based on one or more indicators of possible fraud.

There are over 1,100 Property and Casualty insurance companies and self-insured organizations that comprise the NICB membership base.

A single incoming QC may contain as many as seven "red flags," or reasons for further investigation. Each file is categorized according to type, such as property, casualty, commercial, workers? compensation, vehicle, and miscellaneous.

The areas of possible Workers Compensation fraud that increased the most from 2010 to 2011 on a percentage basis were:

• Duplicate Billing - 207%
  
• Inflated Billing - 113%
  
• Material Misrepresentation on Employment App - 67%
  

The first two are based on questionable activities by medical providers. I found this a little surprising with all of the preferred provider networks and medical bill analysis and review companies that operate in today's Workers Comp environment. Does this mean that medical providers have become more dishonest in the last two years?

The highest non-medical issue for referral to the NICB was the employee not accurately completing the employment application. Through the years, I have seen this occur often in claims. One of the main things left off of the employment application by the employee is the subject of prior injuries or ability to perform a certain job function.

The %'s above are from certain claims from a set group of insurance carriers or TPA's. I do not think there was a large enough base to make any type of statistical inferences. The report can be found here. It may be worth a quick read. You will need a PDF reader to open the document.

Source: http://blogs.cutcompcosts.com/2012/03/workers-compensation-and-national.html

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