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Insurance Fraud to Rise in 2010

We know all too well that insurance fraud (and many other illegal money-making schemes) ramp up in down economies. But what sector of insurance will it hardest in the new year?

According to National Underwriter and the Coalition Against Insurance Fraud, the answer is health insurance. In a survey of 37 fraud bureaus, the Coalition found that the selling of bogus health insurance to small businesses is now the “number one scam.” Other healthcare-related fraud consumers should expect to see in 2010 include medical provider fraud in auto injury and workers comp cases.

Interesting to note is another fraud scheme that has seen a spike during recent, more desperate times — that of the “slip and fall.” Dennis Jay, executive director of the Coalition, stated that incidences of fake slips and falls are “really going through the roof.

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And let us not forget computer hacking fraud.

Ed Goodman, chief privacy officer at Identity Theft 911, said at this point he thinks insurance losses from this kind of crime are difficult to quantify because “the insurance industry is very tight-lipped about it,” and “some numbers you see on the cost of data breach losses are questionable.” However, he guessed that the damage “could well be in the hundreds of millions” and involve soaring legal costs.

As with healthcare-related fraud, computer fraud is more common among small businesses due to lack of appropriate tech security resources.

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The following are seven ways small businesses can prevent computer hacking, thanks to AllBusiness.com:

  1. Implement a firewall
  2. Develop a corporate security policy
  3. Install anti-virus software
  4. Keep operating systems up to date
  5. Don’t run unnecessary network services
  6. Conduct a vulnerability test
  7. Keep informed about network security

Fraud in any form means lost revenue, and in these economic times it’s important for companies to increase protection measures and risk management efforts. What type of fraud is your company preparing for in 2010 and how?

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Insurers to Continue Practice of Rescissions

Everyone who files for independent health insurance is required to fill out an application that lists all pre-existing medical conditions. But what if you fail to mention the fact that you have acne? Or a slightly enlarged blood vessel (which is so non-life-threatening that your doctor doesn’t even shutterstock_medical1mention it to you after a cat scan)?

Failure to mention these small, and seemingly unimportant, medical issues allows health insurers to rescind a policy — especially when a person needs it most.

A new report by congressional investigators states that the practice of policy rescission is common among insurers and saves them millions of dollars a year.

An investigation by the House Subcommittee on Oversight and Investigations showed that health insurers WellPoint Inc., UnitedHealth Group and Assurant Inc. canceled the coverage of more than 20,000 people, allowing the companies to avoid paying more than $300 million in medical claims over a five-year period.

Two cases highlighted at the hearing were that of Robin Beaton and Otto Raddatz. Beaton’s policy was reportedly rescinded a few days before her scheduled mastectomy because she failed to mention she had once visited a dermatologist because of acne. Raddatz’s policy was reportedly dropped when a pre-existing medical condition he was not aware of surfaced after he was diagnosed with lymphoma.

Rep. Bart Stupak (D-MI) was among the lawmakers who grilled health insurance company executives at a congressional hearing last week.

Late in the hearing, Stupak, the committee chairman, put the executives on the spot. Stupak asked each of them whether he would at least commit his company to immediately stop rescissions except where they could show “intentional fraud.”

Each answered “No.”

The outcome of the meeting put the option of a public health insurance plan in a very favorable light.

Proponents of a public plan seized upon the hearing, saying it showed why access to health care cannot be left to private insurance companies.

We will soon see whether a government-run, public health-care plan will serve the uninsured…and hopefully create a more fair world amongst the private insurers.