The results of the National Insurance Crime Bureau's (NICB)latest analysis of questionable claims (QC) referrals havearrived, and it will likely come as no surprise that nearlyall categories posted increases.

Upon examining referrals for six categories—property,casualty, commercial, workers' compensation, vehicle andmiscellaneous—for the third quarters of 2011, 2012, and 2013, theNICB observed a 24-percent uptick in the total number ofQCs.

To put this information into perspective, QCs are claimsthat NICB member insurance companies refer to the Des Plaines, Ill.non-profit agency for closer review and investigation based on oneor more indicators of possible fraud. A single claim maycontain as many as seven referral reasons. The volume ofQC referrals can increase or decrease over a given period of timeand may be caused by a number of factors, including betterreporting by the industry and fluctuations in fraudulentactivity.

During the first three quarters of 2011, the NICB received74,944 QCs. During the first three quarters of 2012, that numberincreased to 87,684, and it increased yet again during the firstthree quarters of 2013 to 93,053. Overall, comparing the firstthree quarters of 2011 to the same period in 2013, the numbers ofQCs increased 24 percent.

As noted above, although most categories of QCs saw increases inthe third quarter, only one, the commercial category, posted adecrease. Referrals for suspicious claims dropped 13 percent in thethird quarter when compared to the previous quarter.

Overall, property QC referral reasons showed no significantchange when the NICB compared 2012 totals to those in2013. This is significant, the NICB says, because forthe first three quarters of 2011 to the same periodin 2012, property QC referral reasons increased overall by 41percent. Moreover, in those three quarters in 2011 and in thefirst three quarters in 2012, all but one of the referralcategories displayed an increase. For 2012 and 2013, twocategories showed a negative percentage change. The highest surgewas found in flood/water damage referrals, which rose 21percent from the first three quarters of 2012 to thefirst three quarters of 2013.

Medical Referrals and Workers' Comp

One of the most dramatic fluctuations was evident in theworkers' compensation disability area, for which QCs increased58 percent during the first three quarters of 2013 compared tothe same period the next year. Also showing double-digitincreases were claims associated with false social security number(40 percent) and false mileage reimbursement (38 percent). Claimantfraud remains the largest workers' compensation referral reason byover two times the next highest referral reason.

There was good news, as duplicate billing QCs decreased awhopping 73 percent. Premium fraud and material misrepresentationon employment application also both declined 23 percent.

Overall, workers' compensation QCs reasons increased 4 percentwhen the NICB compared the first three quarters of 2012 to thesame period in 2013.