Table of Contents
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SECTION 1: AN INTRODUCTION TO INSURANCE FRAUD |
1 |
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WHAT IS THE IMPACT OF INSURANCE FRAUD? |
3 |
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TOP THREE INDUSTRIES AFFECTED BY INSURANCE FRAUD |
5 |
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HEALTHCARE |
5 |
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WORKER'S COMPENSATION |
6 |
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AUTO INSURANCE |
7 |
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SECTION 1— KEY TAKEAWAYS: |
8 |
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SECTION 2: TWO MAIN TYPES OF INSURANCE FRAUD |
9 |
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HARD FRAUD: DELIBERATE AND DAMAGING |
9 |
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SOFT FRAUD: AN OPPORTUNITY TO GET MORE |
10 |
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WHO CAN COMMIT INSURANCE FRAUD? |
11 |
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SECTION 2— KEY TAKEAWAYS: |
13 |
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SECTION 3: REAL-LIFE EXAMPLES OF INSURANCE FRAUD |
14 |
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FRAUD PROFILE 1: ANDY HOUSE |
15 |
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REVIEW |
16 |
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FRAUD PROFILE 2: WANDALE J. FULTON |
17 |
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REVIEW |
20 |
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FRAUD PROFILE 3: JACQUES ROY |
21 |
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REVIEW |
25 |
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FRAUD PROFILE 4: SCOTT CHARMOLI |
26 |
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REVIEW |
29 |
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FRAUD PROFILE 5: JOHN AND ANNE DARWIN |
30 |
|
REVIEW |
33 |
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FRAUD PROFILE 6: LARRY RUDOLPH |
34 |
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REVIEW |
37 |
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FRAUD PROFILE 7: ALI F. ELMEZAYEN |
39 |
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REVIEW |
41 |
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SECTION 3— KEY TAKEAWAYS: |
42 |
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SECTION 4: A CLOSER LOOK AT INSURANCE FRAUD |
43 |
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WHY DO PEOPLE COMMIT INSURANCE FRAUD? |
43 |
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THE FRAUD TRIANGLE |
44 |
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COMMON TYPES OF INSURANCE FRAUD |
48 |
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HEALTHCARE: COMMON INSURANCE FRAUD SCHEMES |
48 |
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Billing for Services That Were Not Provided |
48 |
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Upcoding |
49 |
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Unbundling |
50 |
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WORKERS' COMPENSATION: COMMON INSURANCE FRAUD SCHEMES |
52 |
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Premium Fraud |
53 |
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Experience Modification |
54 |
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Claims Fraud |
55 |
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AUTO INSURANCE: COMMON INSURANCE FRAUD SCHEMES |
57 |
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Vehicle Dumping, False Registration, Exaggerated Repair Costs After an Accident, Faulty Airbag Replacement, Staged Accidents |
58 |
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Swoop & Squat |
58 |
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Drive Down |
59 |
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Go and Stop |
59 |
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SECTION 4— KEY TAKEAWAYS: |
60 |
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SECTION 5: FRAUD DETECTION— HOW TO FIGHT AGAINST INSURANCE FRAUD |
61 |
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DETECTING AND MANAGING RED FLAGS |
62 |
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COOPERATION WITH GOVERNMENT AND LAW ENFORCEMENT AGENCIES |
63 |
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USE OF TECHNOLOGY TO FIGHT FRAUD |
64 |
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THE STATE OF FAUD TECHNOLOGY STUDY: ANTI-FRAUD TECHNOLOGIES |
67 |
|
AML & KYC |
69 |
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Figure 6.2 Types of Anti-Fraud Techniques |
70 |
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SECTION 5— KEY TAKEAWAYS: |
72 |
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SECTION 6: PRACTICAL HELP— WAYS TO PROTECT YOURSELF FROM FRAUD |
73 |
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4 SIGNS THAT YOU'RE GETTING SCAMMED |
73 |
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PRACTICAL STEPS TO PROTECT YOURSELF FROM FRAUD |
74 |
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SAFEGUARD YOUR PERSONAL INFORMATION |
74 |
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UTILIZE TECHNOLOGY TO YOUR ADVANTAGE |
76 |
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USE COMMON SENSE |
76 |
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SECTION 6— KEY TAKEAWAYS: |
78 |
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SECTION 7: INSURANCE FRAUD: WHO'S REALLY PAYING? LESSON REVIEW |
79 |
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SECTION 1: AN INTRODUCTION TO INSURANCE FRAUD |
79 |
|
SECTION 2: TWO MAIN TYPES OF INSURANCE FRAUD |
81 |
|
SECTION 3: REAL-LIFE EXAMPLES OF INSURANCE FRAUD |
82 |
|
SECTION 4: A CLOSER LOOK AT INSURANCE FRAUD |
83 |
|
SECTION 5: FRAUD DETECTION— HOW TO FIGHT AGAINST INSURANCE FRAUD |
84 |
|
SECTION 6: PRACTICAL HELP— WAYS TO PROTECT YOURSELF FROM FRAUD |
85 |
|
ENDNOTES |
86 |