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Definition of Fraud
Types of Fraud
How does fraud affect you?
What you can do to protect yourself
MN
IASIU
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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.
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Coalition Against Insurance Fraud
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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.
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Fraudulent claims account for 10 to
30 cents out of every claim dollar.
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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
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(Accenture Survey – 2004)
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The extent of Insurance Fraud is difficult
to quantify:
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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:
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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
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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
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Life Insurance Fraud
 Faked death
 Murder for Insurance
Health Care Provider Fraud
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Auto Accident Fraud/Organized Ring
Activity:
 Padding claims
 Caused or Staged Accidents
 Jump-ins/Passenger Stuffing
 Fake helpers/Accomplice witnesses
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Cappers/Runners
Professionals
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Staged Accidents
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Medical Providers
Lawyers
Interpreters
All parties knowingly involved
Passenger Stuffing
Caused Accidents
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Targets-Innocent Parties
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Female drivers
Expensive cars
Buses, delivery trucks
18 wheelers
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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
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Someone may come to your door
You may receive mailings from doctors and
lawyers
You may receive phone calls
Organized Fraud Activity
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How to Protect Yourself:
Health Care Provider Fraud
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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
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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
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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
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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.