Put Questionable Claims to Work for You

NICB’s Fraud Bureau Reporting Program facilitates reporting requirements for questionable claims (QCs). We know that is a main reason NICB members submit QCs, but how else do you and your companies benefit from the QC data you and other member companies submit?  

QCs Inform NICB & Law Enforcement Investigations  

Expert NICB Special Agents and Investigators at the Fraud Bureaus receive and review the QCs you submit before categorizing them to be assigned for further investigation. The information you provide informs and directly impacts the success of their investigations. Clearly stated reason for submission narrative, complete location of the loss, identified subjects of investigation, and a list of all investigative resources and case documents provide valuable places to start. Your referral narrative with detailed information will fuel the investigation and help investigators match data with other claims and crimes.  

One final step to speed investigations: provide the direct contact information so the investigator can reach the SIU investigator or the specific individual who is working on the claim. If you submit a general contact number, when the NICB or law enforcement investigator reaches out for more information or to access those identified resources, they will be delayed trying to track down the appropriate resource at your organization.  

ClaimSearch Matches QC Data via Information Sharing 

Criminals don’t limit their fraudulent claims to just one insurance company. They are equal-opportunity fraudsters. When you submit QCs, you and all the NICB members are feeding that information into ClaimSearch to allow data matches to identify repeat offenders. That complete and valuable information helps you avoid paying fraudulent claims and reduce claims costs for your company and policyholders. 

QCs Help 3^rd Party Fraud Detection Partners Contribute to the Fraud Fight 

Through Data Use Agreements, NICB shares information you submit with vetted and approved fraud detection data partners you contract with to leverage their contributions to the fight against fraud. Complete QC data enables additional collaboration in the fraud-fighting community to help your efforts.  

QCs Inform Tactical NICB Intelligence Products and Trend Analysis

NICB employs data analysts and scientists to review the information submitted in QCs. The more detail you provide, the more trends we can identify and alerts we can provide to stop fraud in its tracks. Log into ClaimSearch to access our intelligence reports and see the information you and your teams can use to help identify and drive fraudulent claims from your business. 

Submitting QCs is More Than Fraud Bureau Reporting 

While QC submission brings value to your organization in several ways, we understand that the process takes time and needs to be improved. NICB is currently using member feedback to identify ways to streamline referral reasons and improve the interface for the QC submission process. With member review group guidance, we are working to make the QC submit process more efficient and more valuable. 

While we work behind the scenes, we encourage you to provide as much information as you can in the freeform Reason for Submission box. Let’s work together to reduce the impact of fraud and crime in the insurance industry. 

NICB testified before the NAIC Antifraud Task Force on the value of insurance fraud reporting. As the cornerstone of a united effort between NICB, insurance companies, law enforcement, and regulators, reporting protects consumers and pushes back against a cost driver of insurance. 

Highlighting the importance of fraud reporting, the presentation included a successful multistate investigation led by the Iowa Fraud Bureau and legislative reform in Illinois and Chicago to combat predatory towing.

NICB attended National Conference of Insurance Legislators (NCOIL) Summer Meeting this July. There, Government Affairs Director Craig Sepich spoke on insurance fraud trends, how fraud is evolving, and how regulators can work to defend the most vulnerable in our communities from fraudsters.

Senior Government Affairs Director Howard Handler also stood before the room to testify on NCOIL’s model Storm Chaser Consumer Protection Act. Handler shared NICB’s support for the re-adoption and broadening of the Act's scope to cover service providers in addition to roofers. The NCOIL Property-Casualty Insurance Committee agreed to postpone re-adoption to consider the proposed amendments until the annual meeting this November.   

NICB President and CEO David J. Glawe testified before the Senate Judiciary Committee on the dangers of cargo theft. Following our testimony, we’ve followed up with senators’ questions ahead of the expected CORCA vote this September. Stay tuned for updates in the coming weeks. 

Members can login to ClaimSearch and select the GA tile to access further information on our advocacy efforts. To stay in the know, subscribe to our Legislative Alert.

Many upcoming courses are approved CE credits in DE, FL, NC, and TX. Watch for all impending FraudSmarts and other training events.

Pet Insurance Fraud | August 26
In a FraudSmart designed for insurance-industry, veterinary services, and regulatory body professionals, attendees will gain a deeper understanding of the intricate world of pet insurance fraud. Leave with a clear comprehension of the dynamics, impacts, and prevention strategies for this increasingly relevant form of fraud. CE Credits not available.

Casualty Fraud | August 28 

Casualty fraud is on the rise. In this instructor-led course, attendees will learn to identify schemes and indicators related to this form of fraud, as well as the action steps required to resolve them.

Property Fraud | September 2 

With an increase in fraudulent property claims in response to natural disasters, this FraudSmart is pertinent to those who handle these claims, take first reports, and work in insurance. Attendees will learn about the different types of fraudulent property claims, and the action steps to take. 

Identity Theft & Insurance Fraud | September 4 

Identity theft can have ramifications on an individual’s life for years to come. This course provides an overview of identity theft’s impacts on the insurance industry, as well as how to avoid becoming a victim. Claims workers, underwriters, and insurance company personnel will benefit most from this opportunity. 

Introduction to CPT Codes | September 9 

Being able to identify what CPT codes mean and where to find further information on them is necessary for investigative and insurance professionals who are trying to determine if they are being used properly in medical billing. This introductory course provides a detailed overview of CPT coding and how it is used.

Managing LIST / MIST Claims | September 10 

Perfect for insurance company personnel and those who work in claims, this course offers a thorough overview of both LIST and MIST claims. Develop a clear understanding of fraud indicators that may be associated with these claims, as well as how to prevent it.

Mitigate Medical Claims | September 11 

In a live discussion, Diane Eiten of Nationwide Insurance will answer questions about medical bill reviews, divulging an under-utilized weapon that provides the leg that insurance adjusters can stand on to be able to deny a bill or mitigate a claim. CE Credits not available.

NEW! TNC Fraud | September 16 

This brand-new FraudSmart highlights the limitations of personal insurance for technology-driven services, like ride-sharing. Our instructor will discuss the forms of coverage included in TNC-provided policies, such as bodily injury and property damage. CE Credits not available.

Life Insurance Fraud | September 18

This comprehensive course delves into the intricate world of life insurance fraud, from the various categories to legal and ethical considerations. Participants will leave equipped with the knowledge, skills, and ethical principles necessary to tackle these complex cases effectively. CE Credits not available.

NICB Intelligence Director Lends Her Expertise on The Perfect Scam

Each week, AARP highlights some of the biggest fraud schemes impacting Americans in their podcast, The Perfect Scam. In their recent episode, “VIN Cloning Scams: What Car Buyers Need to Know,” AARP called upon NICB for our expertise in VIN-related fraud and spoke with our Director of Intelligence & Analytics, Jessica Rust. 

Jessica shared NICB’s storied history with VIN fraud, what VIN cloning entails, and how technology has led to the evolution of this crime. Listen to the podcast episode to hear her perspective.

NICB Tackles Fraudulent Tree Removal in Michigan

Where most see moments of natural catastrophe as a time to support others, bad actors may take advantage of those in need. In Michigan, NICB Special Agent Bill Sant’Angelo and the Michigan Attorney General's Office found fraudulent contractors used the aftermath of tornadoes and ice storms to scam victims out of thousands of dollars. 

“Oftentimes [the contractor tells] them, you don't have to worry about paying anything...” Assistant Attorney General Darrin Fowler says. “Sometimes weeks or even a month after that, the insurance company receives a bill for an unpredictable amount of money...That makes the consumer ultimately liable for whatever the insurance company doesn't pay.”

Watch the full story here.

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