DOI: 10.3886/icpsr02627
title: Controlling Fraud in Small Business Health Benefits Programs in the United States, 1990-1996
title: Archival Version

description: 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.
description: 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?
description: 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.
description: 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.
description: Response Rates: Not applicable.
description: Presence of Common Scales: None.
description: All state insurance department actions taken against firms
labeled as MEWA/METs in the RIRS database.
description: Datasets: 
DS1: Controlling Fraud in Small Business Health Benefits Programs in the United States, 1990-1996
description: All regulatory actions taken by state insurance
 departments in the United States against MEWA/MET health insurance
firms from 1990 to 1996.
description: 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.