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Definition of Fraud Types of Fraud How does fraud affect you? What you can do to protect yourself.

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Presentation on theme: "Definition of Fraud Types of Fraud How does fraud affect you? What you can do to protect yourself."— Presentation transcript:


2 Definition of Fraud Types of Fraud How does fraud affect you? What you can do to protect yourself

3 MN IASIU Fraud is deceit; its trickery; its cheating; its committed to cause a person or organization like an insurance company to give up property or some lawful right.


5 Coalition Against Insurance Fraud Insurance Fraud Costs Americans an Estimated; $80 Billion Dollars a Year Cost to you; an estimated $1000 a year per family

6 Insurance Fraud

7 An estimated 3 out of every 10 insurance claims may involve fraud. Fraudulent claims account for 10 to 30 cents out of every claim dollar.


9 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 (Accenture Survey – 2004)

10 The extent of Insurance Fraud is difficult to quantify: Much of it goes undetected Health is endangered Innocent people are killed or maimed Employees lose jobs

11 Insurance Fraud

12 Characteristics of people who are involved in insurance fraud:

13 No-Fault Insurance Fraud Billing for services not provided Performing unnecessary and potentially harmful tests and procedures Workers Compensation Fraud Knowingly lie about work related injury or illness to receive benefits Altered Documents

14 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

15 Life Insurance Fraud Faked death Murder for Insurance Health Care Provider Fraud



18 Auto Accident Fraud/Organized Ring Activity: Padding claims Caused or Staged Accidents Jump-ins/Passenger Stuffing Fake helpers/Accomplice witnesses

19 Cappers/Runners Professionals Medical Providers Lawyers Interpreters Staged Accidents All parties knowingly involved Passenger Stuffing Caused Accidents Targets-Innocent Parties Female drivers Expensive cars Buses, delivery trucks 18 wheelers

20 The Investigators: Counterfeit crashes By Andy Wise - bio | bio MEMPHIS, TN (WMC TV) - One person's fender- bender might be a scam artist's fraud. Copyright 2010 WMC-TV. All rights reserved.

21 The Drive Down






27 Someone may come to your door You may receive mailings from doctors and lawyers You may receive phone calls

28 How to Protect Yourself: Health Care Provider Fraud 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 Organized Fraud Activity

29 How to Protect Yourself: Auto Accident Fraud To avoid caused accidents, such as a Swoop & Squat, dont 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

30 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

31 Law Enforcement? The Government? Individuals? Insurance Industry? Answer: 90% of the public feel the insurance industry should be responsible for fighting insurance fraud.

32 1-888-FRAUDMN1-800-TEL-NICB

33 Fighting fraud is a team sport – we need everyone to win the game.

34 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.

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