Key components of medical cost drivers
A recent report by the NCCI addressed the key components of medical cost drivers — general overall medical costs, facility services, physicians, and prescription drugs.
Medical inflation in WC has been moderate for the past decade. But with the recent dramatic rise in consumer prices, concerns have emerged about medical inflation rising at similar levels.
Two factors drive changes in medical claims costs: the price of medical services and utilization, which measures the mix and number of services provided to an injured worker.
NCCI’s most recent medical data shows that drug costs are declining, physician costs are up slightly, and facility costs are rising in the workers’ compensation system.
Ohio’s workers’ comp market is healthy
- The Ohio Bureau of Workers’ Compensation Special Investigations Department had some impressive results in fiscal year 2022.
- The Special Investigations Department closed 1,431 cases, had 69 convictions, and identified $90 million in savings to the Ohio system, which was the second-highest annual savings since 2007.
- This unit has also been lauded for protecting the state insurance fund, ensuring the workforce is receiving the best care possible, and employers pay their share to help keep premiums low.
- The Special Investigations Department also was adept at catching key cases of fraud involving stolen checks, billing for services not rendered and safety violations.
Major fraud uncovered in California
- Karamjit Nijjar, his wife Rajinder Kaur Nijjar, and their daughter Mandip Nijjar, all of Fresno, Calif., were arraigned on four felony counts each for their involvement in a workers’ compensation insurance fraud scheme.
- The three defendants allegedly underreported over $2.5 million in employee payroll to illegally reduce insurance premiums.
- An investigation into their company, Renteria Trucking, revealed the company reported approximately $2,475,000 in employee payroll during their routine payroll audits.
- However, a forensic audit revealed Renteria Trucking actually had over $5 million in employee payroll for the same time period.
S.C. hires a workers’ comp insurer to assess workplace violence
- The South Carolina Hospital Association and Antum Risk, a workers comp insurer, partnered to address workplace violence in South Carolina’s healthcare facilities.
- The South Carolina-based Antum Risk, which offers a host of risk management services, will allow SCHA members to use their data management system to monitor and track incidents of violence in the workplace.
- This will provide South Carolina’s hospitals and health systems with actionable data to implement strategies to advance workplace safety and prevent acts of violence.
- Data from the U.S. Bureau of Labor and Statistics indicates that the problem has increased over time, rising from an incident rate of 6.4 per 10,000 employees in 2011 to 10.4 per 10,000 employees in 2018.