Report: DME fraud on the rise

Wednesday, January 30, 2013

DES PLAINES, Ill. – There's room to eliminate anywhere from $1.5 billion and $5 billion in DME fraud in a single year, according to a new report by the National Insurance Crime Bureau (NICB). The reason? An uptick in questionable claims (QCs), which have increased consistently since 2009. QCs are referred to the NICB by member insurance companies, which flag certain claims for review based on one or more indicators of possible fraud. A rise in QCs signals that DME fraud may be getting detected at a higher rate. The report, which looked at QCs from Jan. 1, 2009, to June 30, 2012, found that New York (611), Michigan (366), and Florida (54) posted the highest number of QCs during that time.


I feel that to an insurance company, all claims are questionable. They look for any reason they can to not pay a claim. although they NEVER fail to cash a premium check in a lightning quick manner. Articles like this irk me to no end.