NCJ Number
146301
Journal
Security Management Volume: 37 Issue: 11 Dated: (November 1993) Pages: 31- 35
Date Published
1993
Length
5 pages
Annotation
According to the National Health Care Anti-Fraud Association, fraudulent medical expenditures account for as much as $75 billion in annual U.S. health care costs.
Abstract
Some of this tab, picked up by businesses through higher insurance premiums, comes from fraudulent worker compensation claims and staged accidents involving commercial vehicles. The average total claim for on-the-job injuries rose from $8,410 per case in 1981 to $22,795 in 1992. During the same period, medical costs of worker compensation claims rose by 14 percent a year. In response to fraudulent medical expenditures, companies should provide a safe work environment and crack down on fraud with tighter controls and thorough investigations. Workers should be made aware of the serious consequences of filing false injury claims, and companies should develop standard procedures for employees to follow when injuries occur. Companies should also inspect medical clinics and medical records to look for evidence of illegal business activities, fraudulent medical reports, and inflated medical bills. Fraud investigators should request the medical license numbers of doctors and other health care providers to ensure they are licensed to provide the type of treatment indicated on the claimant's medical records. Some of the most difficult fraud cases to prove involve soft tissue injuries and stress-related claims.