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Questionable Medical Claims Up 10 Percent

  • Published: 2010-09-22 : Author: National Insurance Crime Bureau
  • Synopsis: NICB Reports Questionable Medical Claims Up 10 Percent in 2009.

Main Document

NICB Reports Questionable Medical Claims Up 10 Percent in 2009.

Florida and California Lead the Nation

The National Insurance Crime Bureau (NICB) today released new questionable medical claims (QC) data for 2009. The report examines suspected fraudulent medical claims referred to the NICB by its member companies.

In 2009, medical QCs referred to the NICB totaled 28,553 compared with 25,945 in 2008, a 10 percent increase. The top five states producing these QCs are: Florida, California, New York, Texas and Illinois. The top five cities are: New York, Tampa, Miami, Los Angeles and Houston.

Bodily injury was the largest "loss type" category with 12,838 QCs, or 45 percent of the total followed by personal injury protection (PIP) with 4,636 QCs or 16 percent. As for policy type, personal auto accounted for 20,147 QCs or 71 percent of the total in 2009.

The full report is available at

"Suspicious claims related to medical fraud accounted for about a third of all the questionable claims we received from our member companies in 2009, and that number is growing this year," said NICB President and CEO Joe Wehrle. "If the current pace that we've seen during the first half of 2010 continues, we will see a 13 percent increase in questionable medical claims this year versus 2009. This increase is the result of criminal rings stepping up their efforts to steal money from insurance companies and their customers.

"At the same time, the NICB's task force approach with insurance company investigators, law enforcement and prosecutors has made everyone much more aware of these kinds of medical fraud schemes. As a result, we are seeing more scrutiny of claims by insurers and a concerted effort to go after the people involved in this kind of fraud.

"Due to the increase in medical fraud, we recently opened our sixth major medical fraud task force, located in Tampa, and we will soon be adding a seventh one in an area of the country where we are seeing increased activity - the New Jersey, Eastern Pennsylvania and Delaware region."

Anyone with information concerning vehicle theft and insurance fraud can report it anonymously by calling toll-free 1-800-TEL-NICB (1-800-835-6422), texting keyword "fraud" to TIP411 (847411) or by visiting our web site at

About the National Insurance Crime Bureau: headquartered in Des Plaines, Ill., the NICB is the nation's leading not-for-profit organization exclusively dedicated to preventing, detecting and defeating insurance fraud and vehicle theft through information analysis, investigations, training, legislative advocacy and public awareness. The NICB is supported by nearly 1,100 property and casualty insurance companies and self-insured organizations. NICB member companies wrote over $319 billion in insurance premiums in 2009, or more than 78 percent of the nation's property/casualty insurance. That includes more than 93 percent ($151 billion) of the nation's personal auto insurance. To learn more visit

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