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Comment by Mz | Hacker News Reader

Having worked in insurance, my guess is this would be illegal.

They do share information via state regulators (insurance commissioner or state department of insurance) regarding actual fraud once it is proven. Proving fraud requires significant investigation. You have to have more going on than a high rate of recidivism for patients wrestling with addiction for them to accuse you of fraud.

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This seems incredibly backwards. The actions of healthcare providers should not need to rise to the level of legally provable fraud before insurance companies have the option of reporting them. We should be requiring the insurance companies to provide a constant stream of usable statistical data covering ALL providers to regulators/law enforcement who should in turn be free to investigate anything that looks suspicious to them (the same way they would with a driver weaving in his lane or a congressman flashing around a suitcase full of money).

Furthermore: Healthcare providers operating in sectors with low barriers to entry should be constantly subject to random audit/inspection regardless of their stats. Do we wait for a customer to report glass in their food before we inspect a restaurant?

I am surprised to see this comment on a forum where Facebook is routinely decried as Big Brother. How do you propose to protect medical privacy while expecting healthcare providers to report everything as if they are behind the Iron Curtain?

So if this fraud is too "low scale" to be worth fighting, imagine how much profitable fraud exists...

It's not about it being not worthy of a fight. It's about it being difficult to prove because the effects are so small in aggregate.

When I worked at Aflac, they claimed that insurance fraud costs every man, woman and child in the US more than $1000 a year.

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