Stories

Insurers often shrug off fraud

Fighting fraud "is not a top priority" for major insurers, ProPublica reports, because they can just pass along the cost of wasteful spending to enrollees and employers.

Why it matters: Experts say fraud likely accounts for 10% of U.S. health costs. However, "private health insurers, who preside over some $1.2 trillion in spending each year, exhibit a puzzling lack of ambition when it comes to bringing fraudsters to justice," ProPublica's Marshall Allen writes.

Case in point: In California's 14 largest counties, which cover 80% of the state's population, prosecutors filed charges in only 22 fraud cases referred by a commercial insurer in 2017 and 2018 combined.

  • Investigating fraud can be costly for insurers — both financially and in terms of their relationships with providers.

Go deeper, via ProPublica: How to Make Health Insurers Take Fraud Seriously