Health Insurers Request Anti-Fraud Effort Expenses be Included as Part of Claims Experience

July 31, 2012 at 12:32 pm | Posted in Federal Laws, Health and Human Services, Regulations | Leave a comment
Tags: anti-fraud expenses, constitutional, Department of Health and Human Services, fraud

Several representatives of some of the nation’s largest health insurers met with Health and Human Services Secretary Kathleen Sebelius at the White House last Thursday to lobby for change in the medical loss ratio rebate regulations. The proposed change would allow for the insurers’ expenses in combating health insurance fraud to be considered part of a health insurer’s insurance claim or clinical experience.

According to Bloomberg News, some health insurers see the current regulation as creating a disincentive for health insurers to spend more money combating health insurance fraud since, under the current medical loss ratio regulations, the cost of combating fraud is allocated to an insurer’s profit margin as opposed to their claims and clinical experience. The cost of health insurance fraud is not insignificant. For example, the federal government reported that last year it recovered approximately $4.1 billion in fraud in federal health insurance programs.

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