The New York State Insurance Department says “no fault” claims accounted for most of the cases of suspected health care fraud reported to the state in 2010.
The department received 14,625 health care fraud reports, and 12,807 involved no-fault claims, officials say in the New York state insurance superintendent’s annual fraud report.
A “no fault” claim is a claim for an injury caused by an incident in which no one is legally to blame for the injury. The claim may be for care for a nonexistent injury, or for care for a real injury that should not have been covered by the insurance policy that was used.
The New York department also received 1,625 health insurance fraud reports in 2010 and 193 private disability insurance fraud reports.
The department opened 170 new health care fraud cases during the year, and the investigations led to 159 arrests.
The department opened 80 health insurance fraud investigations, 72 no-fault investigations and 18 private disability insurance investigations.
Some of the health insurance fraud cases involved allegations of employees listing ex-spouses or live-in, non-spouse partners as dependents.
In another case, officials say, the department began an investigation of a chiropractor after hearing he “had paid kickbacks to [a company's] employees in order to use their medical information to bill insurance companies” for medical treatments for fabricated injuries.