Health insurance investigators are considering social networking sites such as Facebook, MySpace and Twitter as tools to conduct claims investigations, the Los Angeles Times reports.
The insurance industry says fraud costs the U.S. up to $80 billion annually, accounting for up to 10% of total yearly health care spending.
Insurer Practices
According to National Insurance Crime Bureau spokesperson Frank Scafidi, insurers “look out for things that don’t add up.” For example, insurers could investigate someone who claimed an injury for work but had posted on Facebook about running a marathon.
Insurance companies also are examining whether data available on social networking sites can be used to help underwrite policies.
Mike Fitzgerald — a senior analyst at Celent, the insurance consulting arm of brokerage firm Marsh & McLennan — said insurers could find social media valuable to compare what individuals admit about lifestyle choices and what they reveal online.
Concerns
However, some insurance lawyers say that such practices could lead companies to monitor profiles to raise premiums or deny claims, the Times reports.
Vedica Puri — a partner at Pillsbury & Levinson, a law firm specializing in insurance — said, “The situation is coming up more and more in court where lawyers for insurance companies lay traps for the insured based on pictures or postings on Facebook or Twitter.”
Peter Foley, vice president of claims administration at the American Insurance Association, said insurance investigators could be deemed negligent if they did not scan social media sites for contradictions. He added that anything found on social networking sites should only be a starting point for investigations and not final proof of fraud (Li, Los Angeles Times, 1/25).
Source: iHealthBeat
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