Horizon’s special investigations unit is a team of investigators dedicated to ferreting out insurance fraud within the system. Last year the unit opened 988 cases. So far this year, it has reported 187 cases to the FBI or state enforcement agencies.
The insurer said its antifraud efforts have saved the company $260 million since 2005.
SIU’s report highlighted the “phantom doctor’s office” phenomena as among the most serious threats facing health plans nationwide. Providers use these shell offices to submit fraudulent claims for reimbursement before dissolving the fake company.
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