They are not entitled to any work or another person, knowing that some of the benefits and none of them has the right to refuse to fraudulently obtain a benefit or advantage is committed with the intent of insurance fraud. According to the Federal Bureau of Investigation United States are the most common schemes: Prima Diversion, fees stirring, diversion of resources and workers' compensation fraud. This plan can be both employees and applicants for the insurance of their authors. [1] false insurance claims filed with intent to defraud any insurance company is an insurance claim.
Insurance fraud [2] fraudulent claims received by insurers represent an important part of all claims. Existed since the beginning of insurance as a business, and has been spending billions of dollars annually. Very different types of insurance fraud, and occurs in all areas of insurance. Accident Insurance Crime intentionally causing damage claims bit exaggerating, the range of intensity. Also fraudulent activities, both directly through accidental or intentional injury or damage affecting the lives of innocent people, and indirectly as the insurance premium will be higher because of the crime. Insurance fraud is a very important cause problems, and the government and other organizations to try to prevent such activities.
(Why)
"The main objective of insurance crime is financial gain." [2] insurance contract with the insured and the insurer, providing opportunities for exploitation.
According to the Coalition Against Insurance Fraud, because it's different, but overall greed and hole centers on the fight against fraud. [3] Often, the lower the risk of insurance fraud, see it as a profitable company. Insurance fraud, drug traffickers who entered [4], is safer than the corners and think more profitable. Scammers may try to take advantage of the system compared to other crimes, insurance fraud, the court judgment, may be sensitive. Try to fight insurance fraud claims, although this is often cheaper than the solution, some questionable assertions pay legal system.
Another reason for this opportunity arises that the actual value of the property insured by insurance amount is greater than the insurance, that is the case. [2] This condition is an insurance provider can sometimes be encouraged, especially since it can be very difficult to avoid in order to obtain higher profits. [2] The scammers their insurers to obtain payment destroyed the property is greater than the value of the property destroyed, because they are capable of winning.
False insurance claims can be made to appear as a common claim, the insurance company is susceptible to fraud. Fraudulent claims for damages that have occurred in this file, and so was able to obtain payment of little or no value.
The most common form of insurance fraud losses are increasing.
(Due to the loss of insurance fraud)
It is difficult to determine the right price for the amount of money stolen through insurance fraud. Insurance fraud is a crime like robbery or murder, in contrast, undetectable by fraudsters have been built. As such, it is detected that the number of cases of insurance fraud is actually much smaller than the number of jobs that have been committed. [2] to do to ensure that suffer losses for insurance fraud is to provide an estimate. The Against Insurance Fraud Insurance Fraud Coalition in 2006, due to a total of nearly $ 80 billion in the United States estimated that lost. [5] According to estimates from the Insurance Institute of Information, the property / casualty insurance fraud accounts for approximately 10 percent of the losses of the insurance industry and loss adjustment expenses. [6] National Association of Health Anti-Fraud in the industry of health care in the United States, the cost of 3% of the cost of nearly $ 51 billion, due to the fact that estimates of fraudulent activities. [7] Other estimates of fraud to $ 115 billion annually in the United States up to 10% of the functions of total health expenditure. [8] Another study of all types of fraud committed by the insurance company American (property and casualty, corporate responsibility, health, social security, etc.) of the total cash flow through the system by 38% to 33% to the cost of truth. Book titles JE Smith in this study, insurance trillion spinning result. In the UK, the Office Fraud losses for insurance fraud in the UK due to a 5% increase in insurance premiums, which is approximately £ 1.5 billion ($ 3.08 billion) from the Insurance estimate. [9] The Insurance Bureau of Canada estimates that approximately C $ 500 million a year in Canada, the cost of personal injury fraud. [10] Studies in Indiaforensic insurance fraud over $ 6,250,000,000 annual cost estimate. [11]
(Hard vs Soft fraud)
Insurance fraud is difficult to fraud or soft can be classified as fraud. [12]
Someone deliberately to receive payment for such damages are not covered by your insurance policy a collision, auto theft, or fire, as well as the imposition of planning or a loss when it is difficult fraud. Crime ring that can sometimes difficult to steal millions of dollars are involved in the fraud. [13]
Dura much more common than fraud, counterfeiting, which is soft, refers to fraud as opportunistic times. [12] This type of fraud is increasing, otherwise legitimate claims of policyholders. For example, when an insured person is involved in a collision with a car in his work is very high, can damage claim. Time for a new insurance policy, so a separate misreports pre existing conditions or when your insurance policy for a lower premium, soft fraud may occur. [12]
(Types of insurance fraud)
life insurance
See also: Category: murderers insurance money
Insurance claims fraud life insurance can feigning death. Scammers sometimes memory loss, the claim may be up to a few years after disappearing. [14]
The life insurance fraud is an example of life in December 2007, former teacher who became a British prison officer John Darwin, pseudocide law committed by the investigation, which was the case of the disappearance of John Darwin, after five years, which is believed to have died in a canoeing accident. Darwin claimed to have no memory of the past five years, 21 March, 2002 December 1, 2007 reappeared after a canoe trip after failing to show up for work, miss, as reported.
Another example of a beach in Miami in 1974, former British government minister John Stonehouse is. He assumed the name of Australia, Britain and the transfer of fraud, theft and fraud was discovered living under a sentence of seven years.
Health Insurance
See also: fraud and health care fraud Medicare
Health insurance fraud, deceit, secrecy, or an individual or group health benefits that are the result of the data being corrupted described as a deliberate act.
Fraud can be committed by both the member and provider. Fraud pre-existing Member conditions, and other coverage, prescription drug fraud, and that was the result of claims for work-related injuries not report the non-publication of the application for registration secret member and / or dependents disqualified, consisting changes. Vendor fraud, billing for services that are outside the scope of practice of services, diagnosis or treatment of high level, demanding change, billing and payments under suspension when the license is withdrawn consisting of assertions false submitted by physicians. Independent medical examination to prove a false insurance claims and injury lawsuit to seek a non-biased view of the insurance company or the claimant is allowed to be used.
According to the Coalition Against Insurance Fraud, health care fraud, the taxpayer-funded programs like Medicare exhausted, and doctors say the patient may have. [15] There are some scams that sometimes double billing by physicians involved in treating the costs of insurance and surgeons performing unnecessary surgery. [16]
Roger Feldman, a professor at the University of Minnesota Blue Cross health insurance, medical fraud, according to one of the main reasons why such a common practice in almost all parties involved to find some ways to optimize it. Many doctors do see the need to provide quality care to their patients. Many patients, however, criticized the idea of fraud, sometimes affects their own medicine when you are willing to accept. They want to maximize your service provider and program manager, insurance fraud are sensitive issues. [17]
Health care providers, health insurance fraud are the most common offenders. Historically David Hyman, a law professor at the University of Maryland School, one of the reasons for this, the prevailing attitude of the medical profession patients "justice" is not one. [18] This can be a stimulus, such as fraudulent practices which are not covered by insurance policies patient as well as for the treatment of insurance billing. For this, the doctor often held, is covered by the policy, which is a different service, the bill. [19]
Another motivation for making the health insurance industry as well as in all types of insurance fraud, is the desire for financial gain. They often run on a fee structure for public service programs such as Medicare and Medicaid health, fraudulent activities, are especially useful. [20] In order to achieve this purpose medical use various trick. This "up-coding" or "update" is actually more expensive than providing treatment may include billing, which is involved; And is not obligated to provide medical billing for treatment; Schedule additional visits for patients; They need treatment actually refers patients to another physician; For services not rendered, billing,, phantom billing; With the patient and their families, including those not receiving any services personally or by others "ganging" or billing. [20]
Perhaps the greatest of the total dollar amount of the fraud committed by their own health insurance. Insurance companies pay claims take away intentionally systems, [21] denying coverage canceled, and the going rate for the care they provide is below the hospitals and doctors are not examples of the terrible details of the underpayment of numerous studies and articles. [22 difficult to obtain, even] of fraudulent health claims by insurance companies and the cost of premium payments can be estimated by comparing the proceeds.
Accountability Act of 1996 (HIPAA) in the United States through the Health Insurance Portability and Congress, in response to a growing number of health care fraud, especially in the ten-year sentence in a federal crime has been established and as significant financial penalties in addition to the prison for health care fraud.
(Auto insurance)
Network fraud or the group stage of the accident traffic false or exaggerated or false insurance claims, and could collect the insurance money death. Ring insurance adjusters and claims process claims may be other people who create false police report. [23]
UK Insurance Fraud Office is already causing a motorist to drive more than 20,000 sharply in 2006, produced a tactic is to run a busy junction or roundabout and use the brakes of collisions in the UK since 1999, and is estimated to they have staged a false insurance claim on your return. They are very fast or driving too close behind them, because the other driver was at fault, and up to £ 30,000 can be fabricated claims, whiplash and damage to the insurer of the driver to make a false and inflated claims. [24] In the early years of operation of the Office of Insurance Fraud, insurance fraud, and 74 were arrested in the open network using data mining companies and five to one return on investment. [25]
Insurance Research Council in 1996, claims car insurance estimate that 21-36 percent of suspected elements of fraud. [26] auto insurance providers have a variety of schemes to defraud use. These maneuvers may differ widely in complexity and intensity. Richard A. Derrig, research vice president for fraud Office Massachusetts, a list of auto insurance fraud can occur in a variety of ways Insurance, [27] such as:
(Accident in stages)
Fraudulent innocent party in this category to use a vehicle with an accident in the second stage, where a collision involving staging. Generally, the vehicle collides with innocent party manufacturer, making an unexpected maneuver, where the vehicle can be 4 or 5 mimic. Each fraudulent claims for injuries sustained in a car. An "assignment" to work with the doctor, it is difficult to dispute after injury, whiplash and other injuries to the soft tissues, usually.
Other examples include it jumping in front of the car is made in Russia. Driving conditions and expensive looking cars on the road in front of so many people jumping or hitting them with trying to scam drivers are dangerous. Hit and Run is a very common and specialized insurance claims denials infamous company. Insurance coverage of two paths is very expensive and almost completely available for vehicles over ten years old driver was able to get only basic responsibility. Russian courts do not want to use a verbal statement because most people criminals Dashboard Camera / or provide evidence against the claims of the guard has to be installed. [28]
(Exaggerated statements)
Accidents can happen in a real, but the owner unscrupulous real accidents associated with the least damage to the car in the garage, the bill does not include a wide range of opportunities to take. Especially whiplash injury, may be exaggerated. [29]
(Example)
Insurance fraud automobile Soft is also given to the fact that higher costs for car repairs, a single injury is related to more than one claim for injuries in a car accident, demanding wage losses due to damage and misreporting, or may be included in the report.
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