State insurance commissioners voted today on proposed regulations governing medical loss ratios — the new requirements under health care reform to encourage insurers to spend less on overhead and more on patient care. If insurers don’t spend enough on patient care, they could be forced to rebate a portion of premiums back to policyholders.
The medical loss ratio concept is a fine idea, but when it comes to fraud, the requirement could very well result in perverse incentives. An insurer that is out of balance with the required loss ratios could find it more profitable to disinvest in fraud prevention and just pay suspect claims. Red