definition of fraud types of fraud how does fraud affect you? what you can do to protect yourself
TRANSCRIPT
Objectives
Definition of Fraud Types of Fraud How does fraud affect you? What you can do to protect yourself
What is “Fraud”?
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.
Basically, fraud isINTENTIONAL DECEPTION for the purpose of financial
gain.
How Big Is the Problem of Fraud?
How Big Is the Problem of Fraud?
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
What could your family do with $1000 a year?
Insurance Fraud
According to NICB:
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.
The Reality of Insurance Fraud
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 Cost
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
How else are you affected?
Increase in cost of goods & services
Increase in insurance premiums
Increase in cost of medical care
Insurance Fraud
Characteristics of people who are involved in insurance fraud:
Types of 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
Types of Fraud 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
Fraud Comes in Many Forms
Life Insurance Fraud Faked death Murder for Insurance
Health Care Provider Fraud
ARSON
Owner Give Ups
Organized Fraud Activity
Auto Accident Fraud/Organized Ring Activity:Padding claimsCaused or Staged Accidents
Jump-ins/Passenger Stuffing Fake helpers/Accomplice witnesses
Organized Fraud Activity
Cappers/Runners Professionals
Medical Providers Lawyers Interpreters
Staged Accidents All parties knowingly involved Passenger Stuffing
Caused Accidents Targets-Innocent Parties
Female drivers Expensive cars Buses, delivery trucks 18 wheelers
Staged Accident Scenarios
The Investigators: Counterfeit crashes
By Andy Wise - bio | email MEMPHIS, TN (WMC TV) -
One person's fender-bender might be a scam artist's fraud.
Copyright 2010 WMC-TV. All rights reserved.
The Drive Down
The Freeway Swoop & Squat
The Panic Stop
The Swoop & Squat
Caught On Tape: Staged Accidents
What could happen if you are in an accident?
Someone may come to your door You may receive mailings from doctors and
lawyers You may receive phone calls
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
Organized Fraud Activity
Organized Fraud Activity
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
What Can You do to fight Insurance Fraud?
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
Who Should Fight Insurance Fraud?
Law Enforcement? The Government? Individuals? Insurance Industry?
Answer: 90% of the public feel the insurance industry should be responsible for fighting insurance fraud.
What can you do to fight Insurance Fraud?
1-888-FRAUDMN
1-800-TEL-NICB
Final Thoughts. . .
Fighting fraud is a team sport – we need everyone to win the game.
Questions?
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.