Controlling Fraud in Small Business Health Benefits Programs in the United States, 1990-1996 (ICPSR 2627)

Published: Jun 16, 1999

Principal Investigator(s):
Robert Tillman, St. John's University

https://doi.org/10.3886/ICPSR02627.v1

Version V1

The focus of this project was insider fraud -- crimes committed by the owners and operators of insurance companies that were established for the purposes of defrauding businesses and employees. The quantitative data for this collection were taken from a database maintained by the National Association of Insurance Commissioners (NAIC), an organization that represents state insurance departments collectively and acts as a clearinghouse for information obtained from individual departments. Created in 1988, the Regulatory Information Retrieval System (RIRS) database contains information on actions taken by state insurance departments against individuals and firms, including cease and desist orders, license revocations, fines, and penalties imposed. Data available for this project include a total of 123 actions taken against firms labeled as Multiple Employer Welfare Arrangements or Multiple Employer Trusts (MEWA/MET) in the RIRS database. Variables available in this data collection include the date action was taken, state where action was taken, dollar amount of the penalty imposed in the action, and disposition for action taken.

Tillman, Robert. Controlling Fraud in Small Business Health Benefits Programs in the United States, 1990-1996  . Ann Arbor, MI: Inter-university Consortium for Political and Social Research [distributor], 1999-06-16. https://doi.org/10.3886/ICPSR02627.v1

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United States Department of Justice. Office of Justice Programs. National Institute of Justice (95-IJ-CX-0030)

1990 -- 1996

1997

The user guide and codebook are provided as a Portable Document Format (PDF) file. The PDF file format was developed by Adobe Systems Incorporated and can be accessed using PDF reader software, such as the Adobe Acrobat Reader. Information on how to obtain a copy of the Acrobat Reader is provided through the ICPSR Website on the Internet.

The wave of fraud in the small business health industry began in the late 1970s and has roots in two broad structural changes that affected the availability of health insurance in the United States. During this period, most large insurance companies left the market as many large corporations began to set up their own insurance plans and as Health Maintenance Organizations (HMOs) and other managed care networks began to make significant inroads into the health care market. Particularly hard hit was the small group market comprised of employees of small companies and self-employed individuals. Small business owners saw their health insurance costs rise dramatically and many were unable to find insurance for their employees at any cost. The second change provided the means for committing fraud in the small group market. In 1974, Congress passed the Employment Retirement Income Security Act (ERISA), the primary purpose of which was to safeguard employee pension plans. While ERISA's provisions were intended to make it easier for employers, labor unions, and other organizations to provide health benefits to employees, the unintended effect was to open the doors to con artists who saw in these provisions the legal loopholes that would become the vehicles for massive fraud. The focus of this data project was insider fraud -- crimes committed by the owners and operators of insurance companies that were established for the purposes of defrauding businesses and employees. The main questions addressed were: (1) What are the larger structural causes of fraud in the small business health insurance industry? (2) What are the principal forms that it takes? and (3) What policy changes have been or might be effected that would reduce fraud in the industry?

One of the problems that has hindered research on white-collar crime has been the general lack of systematically-collected quantitative data. The National Association of Insurance Commissioners (NAIC) represents state insurance departments collectively and acts as a clearinghouse for information obtained from individual departments. The quantitative data for this collection were obtained from a NAIC database, the Regulatory Information Retrieval System (RIRS). Created in 1988, the RIRS database contains information on actions taken by state insurance departments against individuals and firms, including cease and desist orders, license revocations, fines, and penalties imposed. Data available for this project include a total of 123 actions taken against firms labeled as Multiple Employer Welfare Arrangements or Multiple Employer Trusts (MEWA/MET) in the RIRS database.

All state insurance department actions taken against firms labeled as MEWA/METs in the RIRS database.

All regulatory actions taken by state insurance departments in the United States against MEWA/MET health insurance firms from 1990 to 1996.

State insurance department action.

Regulatory Information Retrieval System (RIRS) database of the National Association of Insurance Commissioners

administrative records data

Variables available in this data collection include the date action was taken, state where action was taken, dollar amount of the penalty imposed in the action, and disposition for action taken.

Not applicable.

None.

1999-06-16

1999-06-16

1999-06-16 ICPSR data undergo a confidentiality review and are altered when necessary to limit the risk of disclosure. ICPSR also routinely creates ready-to-go data files along with setups in the major statistical software formats as well as standard codebooks to accompany the data. In addition to these procedures, ICPSR performed the following processing steps for this data collection:

  • Checked for undocumented or out-of-range codes.

Notes

  • The public-use data files in this collection are available for access by the general public. Access does not require affiliation with an ICPSR member institution.

NACJD logo

This dataset is maintained and distributed by the National Archive of Criminal Justice Data (NACJD), the criminal justice archive within ICPSR. NACJD is primarily sponsored by three agencies within the U.S. Department of Justice: the Bureau of Justice Statistics, the National Institute of Justice, and the Office of Juvenile Justice and Delinquency Prevention.