SCAM ALERTS

Research

Understanding various aspects of insurance fraud

Technology survey 2012
Anti-fraud technology has been a major contributor to the maturation of insurer anti- fraud programs in recent years. The technology company SAS assisted in the survey of 74 insurers. Nearly all insurers use technology, but vary widely in the sophistication of their systems. Less than half use advanced technologies such as predictive modeling and data mining. The biggest challenges to technology deployment are the need to demonstrate a clear return on investment, and lack of IT resources. Technology isn’t likely to replace the professionalism, instincts and street experience of investigators, but can greatly improve the investigative process. Insurers seem to recognize the importance of technology; less than five percent of respondents expect a decrease in technology funding. Going forward, technology especially will be needed to combat large organized rings, which are a growing insurer focus. The good news is that insurers are planning to invest more in technology. Download pdf file.

Fraud bureau director's survey
The Coalition Against Insurance Fraud conducts a statistical study of state insurance fraud bureaus annually to gauge the overall level of efforts to combat fraud and review year-to-year trends.

Annual statistical study on state fraud bureaus
Budgets, employees, referrals, convictions and investigation have all increased, but some areas are starting to plateau. Learn the full details, and how each state stacks up. Updated annually. 88 pages. Download pdf file.

United We Brand: Toward a National Insurance Fraud Outreach Campaign
Comprehensive white paper discusses existing public outreach programs by fraud bureaus, insurance departments and insurers, the lack of a focused effort and research on effective outreach. Document lays out possible directions for a national outreach campaign on insurance fraud, including message development, focus, funding and possible targeted audiences. 44 pages. Published 2006. Download pdf file.

Insurer fraud measurement
A survey completed by 65 SIU managers, mostly from property/casualty insurers, on their practices involving how they measure anti-fraud activities involving case referrals, fraud savings and performance evaluations of investigators.

SIU study
This study was conducted to learn how insurers measure the performance of their SIUs. A review of the measurement systems of 52 insurers found there is little consistency from insurer to insurer in the methods they use in their performance systems. Download pdf file.

Four faces: why Americans do and don't tolerate fraud
Far too many Americans tolerate fraud, this study reveals. Find out why people accept fraud, and why people sometimes won't report fraud even though they agree scams hike everyone's premiums. Study includes focus groups and statistical survey. 25 pages. Download pdf file.

Licensed to Steal: Action and Inaction by State Medical Boards
State medical boards often take little or no action against medical providers convicted of insurance fraud, this study of 12 states reveals. Recommends how medical boards, courts, insurers and others can tighten their discipline of dishonest medical providers. 16 pages. Click here to download a pdf file.

Effectiveness of warnings on benefit checks
In 2000, selected insurance companies writing workers compensation coverage in the United States were survey to determine their experience and perceptions with printed warnings on the back of benefit checks.

By the numbers
A quick reference list of statistical findings from a variety of research projects and studies involving insurance fraud. Sorted by line of insurance. Download pdf file.

White papers

White paper: Emerging issues
Two separate "emerging issues" workshops were conducted over the course of two days. Each of the groups had spirited, open exchanges in each session. The result was a wide-ranging list of fraud fighting opportunities, problems and threats as we enter the new millennium. It was agreed that technology, globalization, and the changing nature of financial services are accelerating the speed and nature of change. This presents an enormous challenge to all involved in the fraud battle.

White paper: Fraud bureaus
During research on model fraud bureau legislation, the Coalition Against Insurance Fraud identified six potential funding mechanisms for the operation of an insurance fraud bureau. It is the Coalition's view that government has an important role to play in the ongoing fight against insurance fraud. The effort must be a joint partnership of consumers, the insurance industry and government in order to have a real impact on reducing the cost of fraud on premiums consumers and businesses pay, and on the claims costs borne by insurers.

White paper: Fraud Forum
On September 10, 2001 the International Association of Special Investigation Units at their 16th Annual Training Seminar in Palm Springs, CA hosted the first annual update to the 2000 National Fraud Forum. The 2000 National Fraud Forum sponsored by the Coalition Against Insurance Fraud, the International Association of Special Investigation Units, and the National Insurance Crime Bureau, the National Insurance Fraud Forum was held in Washington, D.C. on June 5 — 7, 2000. Attending the 2000 Forum were 100 leaders and experts in the field of insurance fraud. The attendees were representatives of private industry, law enforcement, state fraud bureaus, government regulators and professional organizations.

White paper: Issues
Sponsored by the Coalition Against Insurance Fraud, the International Association of Special Investigation Units, and the National Insurance Crime Bureau, the National Insurance Fraud Forum was held in Washington, D.C. on June 5 — 7, 2000. Attending the forum were 100 leaders and experts in the field of insurance fraud. The attendees were representatives of private industry, law enforcement, state fraud bureaus, government regulators and professional organizations.

Legislation & regulation
Fraud fighters from all parts of the United States met at the National Insurance Fraud Forum in Washington, D.C., June 5-7, 2000 to set a fraud-fighting agenda for the next five years. Their accomplishments included identifying key fraud fighting goals in dealing with legislation and regulation at the state and federal levels and proposing a list of specific developments on which to focus.

White paper: Measuring fraud
Americans live and die by numbers — whether it's political polls, the Dow Jones average, movie ratings or a baseball pitcher's latest earned run average. We have come to expect that all things can and should be measured quickly and easily. Business leaders in the 1980s tried to drive home the point by proclaiming that "if you can't measure it, you can't manage it." The obsession with measuring nearly every aspect of our lives presents a dilemma for the insurance fraud-fighting community. Simply put, insurance fraud is hard to measure accurately. The hidden nature of the crime — combined with other obstacles that will be discussed in this paper — have stymied efforts to develop easy and efficient methods of gauging the extent of fraud, and the effectiveness of specific solutions in curbing it.

White paper: Public/private partnerships
The purpose of these discussion groups was to identify successful public/private partnerships used to fight insurance fraud, and identify how they could be used to model future partnerships to meet the challenge of the millennium. Although such partnerships have been highly effective and are considered important to future successes in fighting fraud, there are legal issues that should be considered when using this approach.

White paper: Public Awareness
Public awareness efforts to combat fraud are fragmented and inconsistent. Numerous industry groups have mounted a variety of campaigns. Some are extensive, well-funded and well-researched, while others are relatively limited. They tend to deploy different strategies, tactics and messages, which further dilutes the overall national impact on fraud reduction.