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Wed Sep 11, 2019, 10:21 PM

We Asked Prosecutors if Health Insurance Companies Care About Fraud. They Laughed at Us.

Like most of us, William Murphy dreads calling health insurance companies. They route him onto a rollercoaster of irrelevant voice menus, and when he finally reaches a human, it’s a customer service rep who has no idea what he’s talking about. Then it can take days to hear back, if anyone responds at all.

The thing is, Murphy isn’t a disgruntled patient. He prosecutes medical fraud cases for the Alameda County District Attorney’s Office in Oakland, California. And when he calls insurers, he’s in pursuit of criminals stealing from them and their clients. But, he said, they typically respond with something akin to a shrug. “There’s no sense of urgency, even though this is their company that’s getting ripped off.”

It’s not just Murphy. I called health care fraud prosecutors across California to ask what insurers were doing to help bring cases against those plundering health care dollars. More than one simply burst out laughing. “Not much,” one prosecutor said.

It seems counterintuitive. Escalating health care costs are one of the greatest financial concerns in the United States. And an estimated 10% of those costs are likely eaten up by fraud, experts say. Yet private health insurers, who preside over some $1.2 trillion in spending each year, exhibit a puzzling lack of ambition when it comes to bringing fraudsters to justice.

Read more: https://www.propublica.org/article/we-asked-prosecutors-if-health-insurance-companies-care-about-fraud-they-laughed-at-us

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Reply We Asked Prosecutors if Health Insurance Companies Care About Fraud. They Laughed at Us. (Original post)
TexasTowelie Sep 11 OP
Phoenix61 Sep 11 #1
TexasTowelie Sep 11 #2

Response to TexasTowelie (Original post)

Wed Sep 11, 2019, 11:24 PM

1. Why would they care. They just raise our

rates to cover the loss.

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Response to Phoenix61 (Reply #1)

Wed Sep 11, 2019, 11:43 PM

2. I think that another reason might be

that if the insurance companies open up their files for review by prosecutors they may find information or business practices that the insurance company may not be conducting legally. FWIW, some insurance companies avoid hiring former state regulators because they may turn into whistleblowers.

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