PIP Fraud
Unlike traditional auto theft, medical fraud has risen dramatically. This type of fraud, such as the abuse of no-fault or personal injury protection (PIP) insurance, often involves organized criminal rings who stage accidents and recruit “victims” to claim phony injuries and big insurance payouts. NICB continues to see a rise in dishonest medical clinics where much more time and expertise is spent filing false insurance claims than actually practicing any form of legitimate medicine.
Medical Billing Fraud
Fortunately, NICB’s Aggregated Medical Database (AMD) has been making vast inroads in identifying potential medical fraud since its creation in 2011. With 33 property-casualty carriers submitting their medical billing data (and more joining soon), the AMD’s analysis has resulted in nearly 2,000 MedAWARESM Alerts identifying over 3,000 providers and nearly 5,000 clinics in 41 states.
These leads reflect over $681 million of medical billing by the providers identified in the MedAWARE Alerts during the time period in which their billing practices were examined. This time period is generally one year in which the dollar value of billing exposure is calculated. The NICB has initiated and concluded cases with successful outcomes based on information contained within the Alerts. More importantly, the information has been valuable to NICB member companies in terms of better identifying providers whose billing practices fall outside the norm, therefore enabling them to successfully pay legitimate claims.
Cargo Theft
Cargo theft continues to pose a serious threat to the U.S. economy, not to mention the insurance industry. As law enforcement resources are stretched, organized criminal rings see cargo theft as a high-reward, low-risk enterprise. NICB agents, deployed in strategic locations throughout the U.S., work with law enforcement and member companies to recover stolen cargo and dismantle the crime rings.
