Consumer information
Insurers respond
Anti-fraud units. Most insurers actively fight fraud with Special Investigation Units — or SIUs. The investigators typically have strong law enforcement backgrounds, or come from elsewhere in an insurer such as the claims department.
Anti-fraud software. Many SIUs use sophisticated software to identify schemes, especially large and complex fraud rings. One of the most powerful programs, predictive analytics, even can forecast the likelihood of certain schemes happening in the future.
Educate consumers. Insurers educate consumers how to protect against being scammed. Insurers also often sponsor toll-free fraud hotlines accept tips through their websites.
Train employees. Most insurers train employees such as adjusters and claims staff how to spot fraud.
Sue swindlers. Some insurers aggressively sue swindlers in civil court. These insurers seek to bankrupt the swindlers and send a strong message to other cheaters that cheating that insurer isn’t worth the risk. Staged accident and health fraud rings are frequent targets.
Sponsor national effort. Property-casualty insurers sponsor the National Insurance Crime Bureau (NICB), whose agents help investigate suspected schemes and refer the suspects for prosecution. NICB also runs a national consumer fraud hotline. Health insurers formed the National Health Care Anti-Fraud Association, which offers training and data for investigating fraud.
Investigations recoup. Health insurers save more than $11 for every dollar spent fighting fraud, says the Health Insurance Association of America.
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