Few comp insurers pursue civil actions, yet suits can gain more restitution, faster than lengthy criminal trials. Insurers can reap penalties, assessments, restitution, contract damages, and/or punitive damages.
High insurance payouts, low scrutiny prompts doctors to bill for forged and incomplete tests. Staged crash rings increasingly are discovering the profit in EMGs.
Burgeoning loans finance lawsuits against insurers, give crash and medical rings greater incentive to bring sketchy claims against insurers. Claimants are charged outrageous interest on loans.
Data, balanced workforce, Millennial focus can help strengthen fraud-fighting in a future filled with new challenges.
Privacy being redefined by vast information fraud fighters can access from connected devices, others sources. Fraud fighters must set fair privacy standards to avoid policymakers imposing standards on them.
Nimble scammers are evolving tactics to overbill insurers for expensive durable medical equipment and compound creams — and launder ill-gotten profits. Insurers are stepping up the pressure with affirmative civil and criminal actions.
Fraud fighters perceive fewer scams; yet organized rings seen growing. Recommendations include closer cooperation between insurers and law enforcement
Anti-fraud tech is growing faster than anyone can fully predict their impact. Forward-thinking insurers are embracing options such as Internet of Things, mobile phones, metadata, geolocation and digital footprints.
Complex rings are hiding workers in shell companies to avoid paying full workers-compensation premiums in construction. Dishonest firms can underbid honest firms for contracts, and injured workers have discovered they’re uninsured.
Insurance fraud remains a large drain on insurers, and on consumers who bear high personal and financial costs this crime imposes. This is why the Coalition surveyed 86 insurance companies about how they deploy anti-fraud technology.
Convicted arsonist says insurers tried too hard to make policyholders happy instead of challenging dubious home fire claims. Bullying tactics helped arsonist get paid for setup fires. Adjusters and claims staff should watch for red flags more closely.
Dramatic legal changes will affect every fire investigator and arson case, and thus every insurer involved in fire-claims litigation. Investigators wishing to justify conclusions from the process of elimination must carefully document all hypotheses considered and ruled out.
As technology transforms data into shared intelligence, claims will be validated more promptly. Increased transparency will eliminate much of the unknown. Decision-making and claim transparency also will reduce a claimant’s opportunity and inclination to defraud.
The workers-compensation system in California is beset with profiteering that jeopardizes injured workers’ lives and health. Play-to-pay schemes are common. Yet prosecutors are turning the corner,charging dozens who’ve milked the state-run system.
Automobile and workers-compensation insurers are the primary targets of scams involving expensive compounded pain creams. Prices are extremely high, yet there is little evidence the creams work. Doctors can make up to $10,000 monthly by prescribing compounded creams, which patients often don’t need.
Employer misclassification of workers leaves injured workers without medical care, and creates an unfair competitive playing field. State agencies in North Carolina are sharing data that is critical to pursuing businesses that illegally misclassify workers.
Harold Henthorn received life in prison for pushing his wife Toni Bertolet off a cliff for $4.6 million of life-insurance money. In a first-person story, the sister-in -law of his first wife chillingly believes Henthorn also targeted her for murder.
Values are the bedrock of any insurance company. Zero tolerance for fraud is a key value. Leaders must create an effective anti-fraud program. That includes a company-wide culture of zero tolerance involving all employes.
Fraud is a serious crime that requires broad interpretations of statutes to effectively fight this crime, several recent court rulings suggest. Dishonest clinics, staged crashes and state-insurer ties recently were scrutinized. Several decision support the Coalition’s policy of urging of courts to broadly construe laws.
Mobile phones and wearables are emerging anti-fraud battlegrounds. ... New York’s Supreme Court will review Facebook’s efforts to block access to accounts in a disability-fraud probe. ... A state agency is ramping up anti-fraud messages. The umbrella name: “Idiots, liars and losers.”
Drones have been used in surveillance of several disability and workers- compensation investigations. They also will add value for property and crop claims, underwriting surveys and arson investigations. Regulations must be developed for anti-fraud concerns.
Deterrent TV spots by a state agency made people less-tolerant of insurance fraud and less likely to commit scams in Pennsylvania. Yet gains were reversed when the spots were suspended. Social marketing can be effective, though must be sustained.
Whistleblower laws in Illinois and California let insurers act against automobile, workers compensation, property and healthcare schemes. Insurers can recover amounts well beyond actual losses — and mobilize state resources.
Some rideshare drivers lie on applications and renewals for personal auto coverage. Some say they aren’t engaged in commercial rideshares, to reduce auto premiums. Insurers must create company-wide policies to uncover schemes.
More workers being misclassified for fraud schemes. ... Fake injuries alerting small businesses to fraud. Many are unsure how to identify employee workers comp scams. ... Healthcare cyber attacks have spiked, are leading source of health data breaches.