Medical Billing Fraud Prevention Platform from Verisk and NICB Receives Insurance Industry Award

January 1, 2011 / 4 min read

JERSEY CITY, N.J., and DES PLAINES, Ill., September 18, 2012 — Verisk Analytics (Nasdaq:VRSK) and the National Insurance Crime Bureau (NICB) have announced the shared winning of the Risk & Insurance Risk InnovatorTM award. The award recognizes Joseph Wehrle, chief executive officer of the NICB, and Vincent Cialdella, president of Verisk Insurance Solutions – Claims and Crime Analytics, for their roles in developing the Aggregated Medical Database (AMD). The AMD helps identify fraud in medical billing, a problem that costs property/casualty insurers in the United States billions of dollars each year.

The Risk Innovator award is given to individuals who have solved tough risk challenges by combining creativity and execution to deliver exceptional results, according to Risk & Insurance.

Wehrle and Cialdella led an effort that included the NICB and Verisk Analytics business units ISO and Verisk Health to deliver a platform to the property/casualty insurance industry that provides the first central repository for the medical bills received by property/casualty insurers.

Property/casualty carriers participating in the AMD supply their medical billing data to Verisk Health (in some cases after a third-party medical bill review). After running the data through its proprietary fraud analysis engine, Verisk Health provides the de-identified results to the NICB, where additional algorithms, developed by ISO, Verisk Health, NICB, and participating member companies search for suspicious activity, issue alerts, and trigger NICB investigations.

As of June 29, 2012 (the Risk Innovator entry deadline), the NICB had issued 385 “MedAWARESM Alerts” (i.e., notices of health care professionals engaging in possible fraudulent activity) to participating property/casualty insurers as a result of the AMD — 155 in 2011 and 230 in the first half of 2012. Additionally, the AMD has resulted in the referral of suspicious medical provider activity amounting to property/casualty carrier exposure of more than $101 million.

In addition to sharing the Risk Innovator award, Wehrle and Cialdella have been designated Responsibility Leaders® by Risk & Insurance for leading the development of a unique and practical offering that benefits the insurance community as a whole and choosing to “do the right thing over the easy thing to overcome obstacles.”

The AMD is an industrywide platform specifically intended to address the threat of medical billing fraud to the property/casualty industry and its customers. In addition to this effort, Wehrle and Cialdella committed to an extended pilot program, lasting more than a year, to ensure that the AMD would directly meet the needs of the industry and its policyholders.

According to Wehrle, “There was no way to get the ‘big picture’ when it comes to the impact of medical billing costs on the property/casualty insurance industry. Insurers spent years being able to investigate only a relative handful of cases of suspected medical billing fraud, even though they knew that much more was occurring. Now, insurers can get a better sense of the full impact — and address it head on.” Wehrle continues, “This couldn’t be accomplished without the commitment of the participating member companies.”

Cialdella says of the AMD development process, “Rather than rush to market, we developed and implemented the solution the industry needs — and that meant the extended pilot program after a year of product development. It was the right thing to do, and the results speak for themselves.”

About Verisk Analytics
Verisk Analytics (Nasdaq:VRSK) is a leading provider of information about risk to professionals in insurance, healthcare, mortgage, government, and risk management. Using advanced technologies to collect and analyze billions of records, Verisk Analytics draws on vast industry expertise and unique proprietary data sets to provide predictive analytics and decision support solutions in fraud prevention, actuarial science, insurance coverages, fire protection, catastrophe and weather risk, data management, and many other fields. In the United States and around the world, Verisk Analytics helps customers protect people, property, and financial assets. For more information, visit www.verisk.com.

About the National Insurance Crime Bureau
Headquartered in Des Plaines, Ill., the NICB is the nation’s leading not-for-profit organization exclusively dedicated to preventing, detecting, and defeating insurance fraud and vehicle theft through data analytics, investigations, training, legislative advocacy, and public awareness. The NICB is supported by more than 1,100 property and casualty insurance companies and self-insured organizations. NICB member companies wrote over $339 billion in insurance premiums in 2011, or approximately 80 percent of the nation’s property/casualty insurance. That includes more than 94 percent ($156 billion) of the nation’s personal auto insurance. To learn more visit www.nicb.org.

Contact:

Erica Helton
MWW Group (for Verisk Analytics)
201-507-9500
ehelton@mww.com

Giuseppe Barone
MWW Group (for Verisk Analytics)
201-507-9500
gbarone@mww.com

Frank Scafidi
NICB
916-979-1510
fscafidi@nicb.org