by Pat Bailer, Life/Health Global Chief Claims Officer, Gen Re
There is rampant fraud and abuse in the Medicare system. It’s no secret healthcare fraud costs taxpayers conservatively $68 billion each year. The impact last year looked something like this:
Healthcare fraud crosses all product lines such as Individual Disability, Group Long Term Disability, Short Term Disability, Medicare Supplement, Dental and Critical Illness.
Medicare fraud’s impact isn’t limited to healthcare. It can and does impact liability decisions in multiple products. If you take a peek at some of the headlines posted by the Office of the Inspector General, you’ll see fraud crosses all product lines in our industry:
The costs are not limited to paying claims that should not be paid. Undetected and unreported fraud also increases premiums paid by honest Insureds.
The old school of thought is that if Medicare pays, the carriers pay. However, Medicare Supplement claims need to be managed just like any other product in your company’s portfolio with the same attention to detail, policy language and specific facts of the claim in mind.
Applying the SIFT concept in your claim organization should be the first step.
Join Gen Re in our live polling session at the ICA Annual Conference to learn more about emerging fraud trends/themes, schemes, providers and vendors negatively impacting our industry and the role, if any, machine learning has in detecting and preventing fraudulent claims.