Social media the latest tool for health care fraud investigators

As social media sites have grown more popular, so has their use by insurance companies that want to know more about the people they insure.

Disability, medical liability and workers' compensation insurers now regularly use Facebook and Twitter to investigate potential fraud, experts say.

And health insurers are using online profiling during the underwriting process. That includes looking at Facebook and Twitter posts or geolocation services such as Foursquare to see where current or prospective members go and what they do, said Owen Tripp, co-founder and chief operating officer of Reputation.com, a Redwood City, Calif.-based firm that helps people and companies monitor and manage their online profiles.

"Insurance companies and representatives of insurance companies are using social media to get an edge on their competition in understanding the risk profile of the insured," he said.

He said the practice includes underwriting -- using posts or tweets to glean whether someone's hobbies are running or skydiving -- and investigating disability claims.

He said patients would be well-advised to stay off any social media sites while they're at home recovering from an injury or an illness to avoid having those posts turn up in a fraud investigation.

Even something innocent could be misconstrued if it indicates the patient is more active than he has claimed. "Frankly, that's an easy case to prosecute if there's a digital record saying you're out and about," Tripp said.

Miami private investigator Daniel Maya, who works for some insurers, detailed how his agency was having a difficult time keeping up with a 23-year-old who claimed to be disabled by injuries from an auto accident. Three investigators kept losing track of him.

But a $500,000 lawsuit against the city where the accident occurred was at stake, so Maya turned to Twitter. He discovered the man tweeted where he was headed every day, including going extreme jet skiing. Investigators showed up and captured video of the jet skiing adventures.

Maya, a former Medicare fraud investigator, said he hasn't seen fraud investigations prompted by or solely supported by Twitter or Facebook posts.

Susan Pisano, a spokeswoman for trade group America's Health Insurance Plans, said health plans aren't using social media as a fraud investigative tool, although she acknowledged that disability insurers have.

Some tips about possible fraud have suggested that Cigna look at Facebook photos or posts, said Joe Mondy, a spokesman for the Philadelphia-based health plan. But the company doesn't proactively monitor social media for signs of fraud.

For one thing, Mondy said, it's not very helpful -- most Facebook users block anyone who isn't a "friend" from seeing their photos or status updates.

But disability, medical liability and workers' compensation cases, where more money is involved, often rely on Facebook and Twitter posts to augment the traditional surveillance and field work, Maya said.

He said insurers use posts or tweets in criminal cases to supplement other evidence of fraud. Auto insurers have turned to social media in personal injury cases to deny claims or push for a quick settlement. Maya said he has seen online postings used in medical liability cases where a patient claims to have been injured under a physician's care but isn't actually hurt.

Maya has tapped into social media to investigate alleged kickback schemes in health care claims. In one case, health clinic owners tweeted invitations to a party they were throwing for a referring doctor. An investigator showed up at the party and found allegedly injured people enjoying themselves.

Social media posts and shared photos aren't enough to make a case, but they can help build one, he said.