What is “Fraud”? - Insurance Federation of Minnesota
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Transcript What is “Fraud”? - Insurance Federation of Minnesota
Definition of Fraud
Types of Fraud
How does fraud affect you?
What you can do to protect yourself
MN
IASIU
Fraud is deceit;
it’s trickery;
it’s cheating;
it’s committed to cause a
person or organization like
an insurance company to
give up property or some
lawful right.
Coalition Against Insurance Fraud
Insurance Fraud Costs Americans an
Estimated;
$80 Billion Dollars a Year
Cost to you; an estimated $1000 a year per
family
Insurance Fraud
An estimated 3 out of every 10
insurance claims may involve fraud.
Fraudulent claims account for 10 to
30 cents out of every claim dollar.
Reasons people commit insurance
fraud:
56% feel they can get away with it
32% feel they are paying too much for
insurance
24% are making up for their deductible
(Accenture Survey – 2004)
The extent of Insurance Fraud is difficult
to quantify:
Much of it goes undetected
Health is endangered
Innocent people are killed or maimed
Employees lose jobs
Insurance Fraud
Characteristics of
people who are involved in insurance fraud:
No-Fault Insurance Fraud
Billing for services not provided
Performing unnecessary and potentially
harmful tests and procedures
Worker’s Compensation Fraud
Knowingly lie about work related injury or
illness to receive benefits
Altered Documents
Slip and Falls
Premium Fraud
Vehicle Thefts
Property Claims
Staged Accidents/Passenger Stuffing
Caused Accidents
Identity Theft Fraud
Paper Cars and Vin Transfers
Multiple Claims
Life Insurance Fraud
Faked death
Murder for Insurance
Health Care Provider Fraud
Auto Accident Fraud/Organized Ring
Activity:
Padding claims
Caused or Staged Accidents
Jump-ins/Passenger Stuffing
Fake helpers/Accomplice witnesses
Cappers/Runners
Professionals
Staged Accidents
Medical Providers
Lawyers
Interpreters
All parties knowingly involved
Passenger Stuffing
Caused Accidents
Targets-Innocent Parties
Female drivers
Expensive cars
Buses, delivery trucks
18 wheelers
The Investigators:
Counterfeit crashes
By Andy Wise - bio | email
MEMPHIS, TN (WMC TV) One person's fenderbender might be a scam
artist's fraud.
Copyright 2010 WMC-TV. All
rights reserved.
The Drive Down
Someone may come to your door
You may receive mailings from doctors and
lawyers
You may receive phone calls
Organized Fraud Activity
How to Protect Yourself:
Health Care Provider Fraud
Ask Questions about Treatment
Review your doctor bills and explanation of
benefits (EOB) form from your insurance
company
Be wary if doctor recommends any new,
unusual or experimental treatment
Be wary if doctor recommends specific attorney
or if attorney recommends specific doctor
How to Protect Yourself:
Auto Accident Fraud
To avoid caused accidents, such as a
“Swoop & Squat, don’t follow other cars too
closely
Look beyond the car in front of you while
driving. Avoid distractions; cell phone, etc.
If you are in accident you believe is staged,
insist on calling the police and tell your
insurance company
Call Police
Call your Insurance Agent-even if the accident
is minor
Take photos of damage and people
Note plate #
Note number of people in the car
Do not leave the scene
Law Enforcement?
The Government?
Individuals?
Insurance Industry?
Answer: 90% of the public feel the insurance
industry should be responsible for fighting
insurance fraud.
1-888-FRAUDMN
1-800-TEL-NICB
Fighting fraud is a team sport – we
need everyone to win the game.
Thank you!
Information gathered for this presentation was obtained through the Minnesota Chapter of the International Association of Special
Investigation Units (MN IASIU) and outside sources.