Insurance Claims Investigation News

Lesley Campbell

ANYONE considering taking a spectacular fall on a loose paving stone then lodging a spurious insurance claim should now think twice. More than £3.5m a week in insurance fraud is now being detected by the industry using a raft of new measures.

Revelations of fraud continue to come from the usual sources: the spurned wife who reports her departed husband for exaggerating injuries in a car accident; or the man who claims to have been laid low by a back injury shown collecting an award as the top goal scorer for his local football team.

But information on possible fraudsters is coming increasingly from the new database which allows insurers to compare information. As a result, the detection rate is now 95% up on 2002 levels.

The Association of British Insurers, whose members make up two-thirds of the general insurance industry, have justly hailed the new figures as a victory.

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Article by SAMUEL MAULL
Associated Press Writer

March 22, 2005, 6:01 PM EST

NEW YORK — A Manhattan grand jury has indicted 15 people, including four doctors and a dentist, on charges of stealing millions of dollars from New York City Transit and numerous insurance companies through fraudulent medical billing.

The indictment also named six companies, which included a medical billing firm, a psychologist\’s office, an acupuncture clinic and three medical clinics, as participants in the fraud. The companies had offices in Brooklyn, Manhattan or both.

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On March 16, investigators from the Fresno County Urban Organized Auto Insurance Fraud Task Force and officers from the Stockton Police Department arrested three california residents who are alledged to be arranging auto thefts and burns to falsify insurance claims.
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Twelve BlueCross BlueShield Association insurance plans filed a civil lawsuit on Thursday against nine surgery clinics in California, as well as 21 doctors and 13 owners, employers or administrators of the clinics, alleging their involvement in \”an elaborate insurance scheme\” involving thousands of patients from 47 states and more than $1 billion in fraudulent insurance claims, the New York Times reports (Pear, New York Times, 3/12). About 90 other insurance companies also were billed for unnecessary surgeries in the alleged scheme, the Los Angeles Times reports (Reza/Alonso-Zaldivar, Los Angeles Times, 3/12).

Florida lawmakers increased punishments for making insurance claims for fraudulent medical services in 2001, but the move has failed to curb auto insurance rates. The law has increased investigations and arrests for fraud. Legislators say that a radical revision to the insurance code may be needed in order to curb the incidence of fraud, which is estimated cost Florida motorists $1 billion annually.

HARLESTON, S.C. – A Senate subcommittee has proposed giving the state attorney general\’s office an additional $400,000 to hire six more prosecutors to fight insurance fraud. As reported by the Associated Press

LOS ANGELES — Twenty-seven citations and $186,000 in assessments were issued in the first three days of a countywide sweep of businesses suspected of operating without workers\’ compensation insurance, officials said Monday. The sweep, which began last Tuesday and is scheduled to conclude Tuesday, is a joint effort between the Division of Labor Standards Enforcement and the Los Angeles County District Attorney\’s Office Workers\’ Compensation Fraud Division.

Online insurer Esurance has launched a new webpage, located at http://www.esurance.com/insurance/fightfraud.asp , to educate consumers about recognizing and preventing the problem of insurance fraud. Esurance, a subsidiary of White Mountains Insurance Group, Ltd., provides personal auto insurance direct to consumers online and through select online agents.

A story of open solitication of participants for auto insurance fraud in Lawrence, MA as reported by the Boston Globe.

The New Jersey Star Ledger reports jail sentences triple in insurance fraud cases and restitution risessuring \’04. Great articvle by BY RICK HEPP
Star-Ledger Staff

Zany, bogus scams don\’t fool insurers. Canadian Fraud Coalition releases 2004 list These stories strange but trueCoalition Against Insurance Fraud releases 2004 list. Read here

Doctor accused of violating rules by billing millions for unnecessary wheelchairs. Read Complete Story Here

Toronto police break up fraud ring and find that most of the \”cars\” that were stolen never existed. Police arrested 16 people in connection with the scam this week.

Themis Georgakopoulos, 33, and Dominico Fratia, 38, are accused of leading the operation. They are each charged with 12 counts of fraud, seven counts of conspiracy to commit fraud and seven counts of public mischief.

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Investigators from the California Department of Insurance\’s Fraud Division (CDI) conducted joint operations in the Central Valley to execute outstanding arrest warrants. This sweep netted eight suspects, including six wanted by CDI for felony insurance fraud. Read here.