Buffalo near top for fake medical claims

April 14, 2011 Updated Apr 14, 2011 at 7:24 AM EDT

By Tracey Drury, Business First


Buffalo near top for fake medical claims

April 14, 2011 Updated Apr 14, 2011 at 7:24 AM EDT

Buffalo continues to be home to an unusually high number of questionable medical insurance claims, according to a new report by the National Insurance Crime Bureau (NICB).

With 145 questionable claims, Buffalo was second only to New York City, which had a whopping 4,016 questionable claims or 57 percent of the statewide total. A total of 7,026 questionable claims were filed across New York state in 2010, up 10 percent from 2008, when 6,378 were referred to NICB from its member insurance companies.

The numbers were included in the 2010 questionable claims analysis for New York, released April 13 by the Des Plaines, Ill.-based bureau. Nationwide, questionable claims increased by 24 percent between 2008 and 2010, with 91,797 QCs received last year.

Questionable claims can contain up to seven referral reasons, though most were for "faked/exaggerated injury" followed by "excessive treatment" and "staged/caused accident."

The NICB, a not-for-profit organization dedicated to preventing, detecting and defeating insurance fraud and vehicle theft, first opened its Major Medical Fraud Task Force in New York in 2002 in response to escalating incidents of fraud associated with medical claims. Another six offices have opened since in other cities across the country.

Most of the questionable claims stemmed from personal automobile policies, which accounted for 83 percent of all QCs in 2010. During the three year period studied in the new report, 80 percent came from such policies. In a NICB press release, Joe Wehrle, president and CEO, said New Yorkers need to support a state bill aimed at amending the insurance law to include reforms to reduce fraud, abuse and associated costs in the state's no-fault system.

"This bill would deliver comprehensive reform to New York's no-fault system while preventing much of the fraud we see conducted by illegitimate clinics and their patients - receiving treatments for non-existent injuries sustained during phony accidents," he said.

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