News
Fraud is blamed for cost of insurance policies
Health insurance customers are paying up to 5 per cent over the odds for their policies to cover the cost of insurance fraud, an international industry expert has warned.Dr Simon Peck, a founding member of the Health Insurance Counter Fraud Group (HICFG) in Britain, said that insurers needed to install the most up-to-date technologies to detect and eliminate fraud. ‘‘Healthcare fraud affects all healthcare systems," said Peck, who is also head of audit and information at Axa PPP Healthcare in Britain.
‘‘Our own research in Britain indicates that fraud-related losses could account for 5 per cent of policy holders' premiums, and possibly more than that.
‘‘In the US, the cost of healthcare fraud is thought to be $150 billion [€100 billion].
What is important is that insurance companies get together and share information."
Peck said that the main types of healthcare fraud included upcoding, where a medical provider charged for a more complex procedure than was performed; over-treatment, where a provider billed for treatments that were not medically necessary; and misrepresenting, where claimants either omitted or overstated their medical complaints.
Medical specialists are rated as the highest offenders for overcharging for procedures.
Paul Power, client director for software firm SAS, which provides anti-fraud software to insurers, said the downturn had brought greater levels of ‘‘opportunistic fraud''.
Peck added that the group hoped to sign an agreement in the near future for Irish insurers to use its resources.
>> The Post.IE