Insurance Companies Using Social Networks to Detect Fraudulent Claims

Health care investigators are using social networking tools like Facebook and Twitter to detect fraud cases, says a new report from the American Medical Association (AMA). By taking a closer look at the people they insure, investigators are gaining insight into medical liability and other health care scams.

Investigators Are Watching You

Social networks have already become known as the hot spot for employers who want to conduct lightweight background checks on prospective employees, but now these sites are becoming more popular in other areas of business, particularly insurance companies that want to make sure policyholders receiving claims payouts deserve the money.

According to the AMA, now that social media sites like Twitter and Facebook have become immensely popular, and many of its users now feel comfortable enough to share the events of their day, companies have been able to follow their activities to determine whether those who are being paid claims are running health insurance scams.

The insurers initially gain access to patient sites by using online profiling during the underwriting process. By seeing what prospective and current policyholders do and where they go, they determine whether the person is due their claim.

Be Careful When Using Social Networks While Recovering

Because companies have begun using social networks to investigate fraud, the AMA warns anyone who has a medical injury, disability or worker’s compensation claim to steer clear of social networking while at home recovering.

Companies and their representatives are looking for an edge in stopping fraud, the association said, so if you post any activity that looks suspicious–even if you are genuinely injured or ill–the company may view your case as a scam and stop issuing payments.

In our 2009 story, Top 8 Worst Health Insurance Denial Cases, we revealed that teenagers had been denied coverage for anorexia and bulimia because their Myspace and Facebook postings led insurers to believe that their illnesses were caused by mental illness, which in their state of residence, does not have to be insured if not biologically based.

Experts have always warned about sharing too much information on social networking sites for safety purposes. But if you are currently receiving an insurance claim, you have even more of a reason to stop the status updates and picture posting for the time being.