Download or read book Insurance Fraud the Crime We All Pay for written by and published by . This book was released on 2001* with total page 6 pages. Available in PDF, EPUB and Kindle. Book excerpt:
Download or read book Insurance Fraud Casebook written by Laura Hymes and published by John Wiley & Sons. This book was released on 2014-07-22 with total page 292 pages. Available in PDF, EPUB and Kindle. Book excerpt: Real case studies on insurance fraud written by real fraud examiners Insurance Fraud Casebook is a one-of-a-kind collection consisting of actual cases written by fraud examiners out in the field. These cases were hand selected from hundreds of submissions and together form a comprehensive picture of the many types of insurance fraud—how they are investigated, across industries and throughout the world. Entertaining and enlightening, the cases cover every type of insurance fraud, from medical fraud to counterfeiting. Each case outlines how the fraud was engineered, how it was investigated, and how perpetrators were brought to justice Written for fraud examiners, auditors, and insurance auditors Other titles by Wells: Fraud Fighter and Corporate Fraud Handbook, Third Edition Edited by Dr. Joseph T. Wells, the founder and Chairman of the Association of Certified Fraud Examiners (ACFE), the world's leading anti-fraud organization, this book reveals the dangers of insurance fraud and the measures that can be taken to prevent it from happening in the first place.
Download or read book Broken Promises written by Robert Tillman and published by UPNE. This book was released on 1998 with total page 230 pages. Available in PDF, EPUB and Kindle. Book excerpt: As the costs of medical care have skyrocketed, so has the amount of money lost to fraudulent health insurance providers. These bogus operations typically victimize individuals on the lower end of the socioeconomic scale who then face staggering medical bills without coverage. Robert Tillman shows how market conditions and weak regulatory structures have allowed these crimes to occur, and cites recent institutional and legal changes that have created both new demands for insurance and greater opportunities for fraud. He also analyzes the political and economic climate that enables these criminal practices to flourish. Drawing on court documents, congressional hearings, and actual cases, Tillman provides numerous examples of the three most prevalent forms of fraud: scams involving multiple employer welfare arrangements, employee leasing schemes, and fictitious labor unions. He also examines recent innovations in insurance fraud such as "24-hour plans" and coverage offered by dubious religious organizations. With the regulation of health insurance currently in chaos, Broken Promises offers a critical examination of this insidious form of white-collar crime. It is a timely book that raises important questions about the definition of insurance and consumer protection.
Download or read book Insurance Fraud written by Louisiana. Insurance Department and published by . This book was released on 2004* with total page 1 pages. Available in PDF, EPUB and Kindle. Book excerpt:
Download or read book Insurance Fraud Volume II written by Barry Zalma and published by . This book was released on 2019-10-31 with total page 460 pages. Available in PDF, EPUB and Kindle. Book excerpt: Insurance Fraud Is Epidemic Insurance fraud continually takes more money each year than it did the last from the insurance buying public. There is no certain number. Most attempts at insurance fraud succeed. Estimates of the extent of insurance fraud in the United States range from $87 billion to more than $300 billion every year.Insurers and government backed pseudo-insurers can only estimate the extent they lose to fraudulent claims. Lack of sufficient investigation and prosecution of insurance criminals is endemic. Most insurance fraud criminals are not detected. Those that are detected do so because they became greedy, sloppy and unprofessional so that the attempted fraud becomes so obvious it cannot be ignored.The National Insurance Crime Bureau (NICB) estimates that almost 25% of the bodily injury claims related to auto crashes are bogus. Property and casualty claims against auto insurance are not much better, coming in at around a 10% fraud rate.A person commits the offense of insurance fraud by knowingly and with the intent to defraud any insurer presents or causes to be presented to any insurer any statement forming a part of, or in support of, a claim that contains any false, incomplete or misleading information concerning any fact or thing material to the claim. [18 Pa.C.S.A. § 4117(a)(2).] A person acts "knowingly" when he or she is aware that it is practically certain that his or her conduct will cause such a result. Likewise, a person acts "intentionally" when "it is his or her conscious object to engage in conduct of that nature or to cause such a result.As the industry attempts to keep pace with fraudsters' varied, ever-shifting tactics, it must deploy more innovative, effective anti-fraud technologies or risk dire losses. Vendors and organizations include the Coalition Against Insurance Fraud (CAIF), CSC, Detica NetReveal, Equifax, Experian, FICO, IBM, Innovation Group, Insurance Bureau of Canada (IBC), ISO/Verisk, KPMG, LexisNexis, Mattersight, Mitchell, the National Insurance Crime Bureau (NICB), SAP, SAS, and TransUnion.Insurers must also generate a close relationship with the state insurance department's fraud division or fraud bureau, local police agencies, the FBI, the ATF, the Postal Investigation Service, the local fire department's arson unit, local prosecutors, and the local U.S. Attorneys if they are to have any chance to reduce the effect of insurance fraud. Insurers should also work to make the general public, state legislators, state governors, congress members and U.S. Senators, and the Attorney General of the United States aware of the effect insurance fraud has on the public at large and the insurance industry.Wherever insurance is written insurance fraud exists. It is an equal opportunity fraud committed by people of every race, religion or national origin. Insurers who do not exercise serious anti-fraud efforts often complain that the local district attorneys and police agencies give a low priority to the crime of insurance fraud. No matter how seriously the insurers work to prove fraud the authorities often ignore them. In response, police and prosecutors complain that the insurers do nothing that police and prosecutors can use to prosecute the crime of insurance fraud while insurers complain that prosecutors ignore them when they present evidence of a fraud. There is truth in both complaints. Insurers, although compelled by statute to investigate potential insurance fraud and to present the results of their investigations to prosecutors, they are not trained as police officers. This book is written to make it clear to insurers, police and prosecutors that it is necessary to stop complaining and start working together to reduce the extent of insurance fraud. If they do not work together the crime will continue to metastasize until it will be impossible to write insurance at a profit or for a price anyone can afford.
Download or read book Insured for Murder written by Robin Yocum and published by Prometheus Books. This book was released on 2010-10-05 with total page 290 pages. Available in PDF, EPUB and Kindle. Book excerpt: All the ingredients of a first-rate thriller stand out in this investigative report by Robin Yocum and Catherine Candisky, who reveal a sinister and deadly con game that was three years in the making: a murder, an insurance scam with a multi-million dollar payoff, a playboy businessman, a sinister stun-gun-toting neurologist, false identities, and an international manhunt. On the morning of April 16, 1988, the emergency squad was called to the office of Dr. Richard P. Boggs, a respected neurologist in Glendale, California. On the floor of the examining room was the body of Melvin E. Hanson, the vice president of the Just Sweats athletic clothing store chain, based in Columbus, Ohio. Apparently, he had collapsed and died of heart failure during a routine examination. Early next morning, Hanson''s business partner and the company president, John B. Hawkins, arrived from Columbus and had the body unceremoniously cremated. The coroner ruled that Hanson died of natural causes, so there was nothing to be investigated, and the Glendale police did not pursue the case further. But this wasn''t just another unfortunate death. There was something very, very wrong here. The body lying on the floor was not Hanson''s. The corpse was an anonymous double who had been murdered in a scheme to fraudulently collect on Hanson''s life insurance policy.
Download or read book Global Pirates written by Robert Tillman and published by UPNE. This book was released on 2002 with total page 194 pages. Available in PDF, EPUB and Kindle. Book excerpt: A critical investigation of international insurance fraud.
Download or read book Insurance Fraud Volume I Second Edition written by Barry Zalma and published by Independently Published. This book was released on 2022-03-12 with total page 408 pages. Available in PDF, EPUB and Kindle. Book excerpt: INSURANCE FRAUD IS EPIDEMIC Insurance fraud continually takes more money each year than it did the last from the insurance buying public. There is no certain number. No one knows the amount that is taken by insurance fraud because most attempts at insurance fraud succeed. Estimates of the extent of insurance fraud in the United States range from $87 billion to more than $300 billion every year. The only certainty is that it is a serious crime that bleeds the insurance industry sufficiently to have states compel insurers to create special investigative units (SIU's) to investigate, deter and defeat insurance fraud to assist the state in its efforts to prosecute the crime. Insurers and government backed pseudo-insurers can only estimate the extent they lose to fraudulent claims. Lack of sufficient investigation and prosecution of insurance criminals is endemic. Most insurance fraud criminals are not detected. Those that are detected do so because they became greedy, sloppy and unprofessional so that the attempted fraud becomes so obvious it cannot be ignored. The National Insurance Crime Bureau (NICB) estimated that almost 25% of the bodily injury claims related to auto crashes are bogus. Property and casualty claims against auto insurance are not much better, coming in at around a 10% fraud rate. The National Association of Insurance Commissioners (NAIC) reports that insurance fraud occurs when an insurance company, agent, adjuster or consumer commits a deliberate deception in order to obtain an illegitimate gain. It can occur during the process of buying, using, selling, or underwriting insurance. Insurance fraud may fall into different categories from individuals committing fraud against consumers to individuals committing fraud against insurance companies. Non-medical insurance fraud is estimated at over at $40 billion dollars per year. Fraud not only inflicts extra costs on insurance companies, but it also financially impacts consumers, costing the average U.S. family between $400 and $700 per year in premiums. When insurers and governments put on a serious effort to reduce the amount of insurance fraud the number of claims presented to insurers and the pseudo-government-based or funded insurers drops logarithmically. Insurance fraud is not limited to the US. In Britain fraud costs the British economy amounts estimated in billions of British pounds. Since the amount of fraud actually detected is a small portion of what was actually found, the estimates published are little more than an educated guess. Vendors and organizations include the Coalition Against Insurance Fraud (CAIF), CSC, Detica NetReveal, Equifax, Experian, FICO, IBM, Innovation Group, Insurance Bureau of Canada (IBC), ISO/Verisk, KPMG, LexisNexis, FastCase, Mattersight, Mitchell, the National Insurance Crime Bureau (NICB), SAP, SAS, and TransUnion. No matter how seriously the insurers work to prove fraud the authorities often ignore them. In response, police and prosecutors complain that the insurers do nothing that police and prosecutors can use to prosecute the crime of insurance fraud while insurers complain that prosecutors ignore them when they present evidence of a fraud. There is truth in both complaints. Insurers, although compelled by statute to investigate potential insurance fraud and to present the results of their investigations to prosecutors, they are not trained as police officers. Insurance company employees, whether claims adjusters or SIU investigators are not trained to present evidence of a crime to a court. They can only advise professional insurance fraud investigators at the state departments of insurance or state police agencies who must then investigate further to obtain evidence that is sufficient for a charge of insurance fraud or to convince a Grand Jury to issue an indictment.
Download or read book License To Steal written by Malcolm K Sparrow and published by Basic Books. This book was released on 2007-12-14 with total page 306 pages. Available in PDF, EPUB and Kindle. Book excerpt: Who steals? An extraordinary range of folk -- from low-life hoods who sign on as Medicare or Medicaid providers equipped with nothing more than beepers and mailboxes, to drug trafficking organizations, organized crime syndicates, and even major hospital chains. In License to Steal, Malcolm K. Sparrow shows how the industry's defenses, which focus mostly on finding and correcting billing errors, are no match for such well orchestrated attacks. The maxim for thieves simply becomes "bill your lies correctly." Provided they do that, fraud perpetrators with any degree of sophistication can steal millions of dollars with impunity, testing payment systems carefully, and then spreading fraudulent billings widely enough across patient and provider accounts to escape detection. The kinds of highly automated, quality controlled claims processing systems that pervade the industry present fraud perpetrators with their favorite kind of target: rich, fast paying, transparent, utterly predictable check printing systems, with little threat of human intervention, and with the U.S. Treasury on the end of the electronic line. Sparrow picks apart the industry's response to the government's efforts to control this problem. The provider associations (well heeled and politically influential) have vociferously opposed almost every recent enforcement initiative, creating the unfortunate public impression that the entire health care industry is against effective fraud control. A significant segment of the industry, it seems, regards fraud and abuse not as a problem, but as a lucrative enterprise worth defending. Meanwhile, it remains a perfectly commonplace experience for patients or their relatives to examine a medical bill and discover that half of it never happened, or that; likewise, if patients then complain, they discover that no one seems to care, or that no one has the resources to do anything about it. Sparrow's research suggests that the growth of capitated managed care systems does not solve the problem, as many in the industry had assumed, but merely changes its form. The managed care environment produces scams involving underutilization, and the withholding of medical care schemes that are harder to uncover and investigate, and much more dangerous to human health. Having worked extensively with federal and state officials since the appearance of his first book on this subject, Sparrow is in a unique position to evaluate recent law enforcement initiatives. He admits the "war on fraud" is at least now engaged, but it is far from won.
Download or read book The Insurance Fraud Deskbook written by Barry Zalma and published by American Bar Association. This book was released on 2014 with total page 0 pages. Available in PDF, EPUB and Kindle. Book excerpt: This book is written for individuals who are focused on the effort to reduce expensive and pervasive occurrences of insurance fraud. Lawyers who represent insurers, claims personnel, prosecutors and their investigators can all benefit from this exhaustive resource.
Download or read book Every Crime Leaves a Trace So Does Insurance Fraud written by Louisiana Auto Theft and Insurance Fraud Prevention Authority and published by . This book was released on 2011 with total page 1 pages. Available in PDF, EPUB and Kindle. Book excerpt:
Download or read book Claims Costs and Crimes written by Lee S. Cole and published by . This book was released on 1984 with total page 120 pages. Available in PDF, EPUB and Kindle. Book excerpt:
Download or read book Tackling Insurance Fraud written by Lynne Skajaa and published by Taylor & Francis. This book was released on 2020-11-25 with total page 198 pages. Available in PDF, EPUB and Kindle. Book excerpt: Insurance fraud is a growing problem on a global scale. The ABI estimates that fraudulent insurance claims on motor and household policies alone cost insurers in excess of £1 billion every year. This book provides an analysis of the insurance industry’s response to the problem and examines fraud from legal and practical perspectives to determine how to manage and reduce fraud. Key issues covered include: fraud in the insurance and reinsurance context, a look at industry-wide initiatives and individual insurance companies’ approaches to the problem, consideration of recent legal developments and a look at how insurance fraud is tackled in other jurisdictions. Includes a chapter on marine insurance fraud.
Download or read book You Paid For This written by Richard Wickliffe and published by . This book was released on 2024-04-29 with total page 0 pages. Available in PDF, EPUB and Kindle. Book excerpt: Embark on a gripping 25-year journey delving into the author's investigation of insurance crimes in Miami, spotlighting Special Investigation Units (SIU) -an investigative world invisible to most, yet one for which we all pay. In YOU PAID FOR THIS, Richard Wickliffe takes the reader from routine burglaries to art theft on the high-seas, arson for profit, and even failed ritual sacrifices. He describes a variety of cases he encountered, including the Russian mob and organized crime, boat thefts linked to unconscionable human trafficking, sunken cars that conceal deadly secrets, and the pitfalls of faking one's death. The book culminates with the SIU's involvement in Miami's harrowing Pain & Gain double murder case, featuring kidnapping, extortion, and mutilation. With an informative yet witty tone, YOU PAID FOR THIS exposes the creative and chilling facets of insurance crimes, cautioning and advising readers on how to protect themselves from potential victimization in their own lives.
Download or read book Contemporary Issues in Audit Management and Forensic Accounting written by Simon Grima and published by Emerald Group Publishing. This book was released on 2020-02-10 with total page 487 pages. Available in PDF, EPUB and Kindle. Book excerpt: In the 18 chapters in this volume of Contemporary Studies in Economic and Financial Analysis, expert contributors gather together to examine the extent and characteristics of forensic accounting, a field which has been practiced for many years, but is still not internationally regulated yet.
Download or read book Insurance Fraud written by and published by . This book was released on 2014 with total page 16 pages. Available in PDF, EPUB and Kindle. Book excerpt:
Download or read book The Little Black Book of Scams written by Industry Canada and published by Competition Bureau Canada. This book was released on 2014-03-10 with total page 45 pages. Available in PDF, EPUB and Kindle. Book excerpt: The Canadian edition of The Little Black Book of Scams is a compact and easy to use reference guide filled with information Canadians can use to protect themselves against a variety of common scams. It debunks common myths about scams, provides contact information for reporting a scam to the correct authority, and offers a step-by-step guide for scam victims to reduce their losses and avoid becoming repeat victims. Consumers and businesses can consult The Little Black Book of Scams to avoid falling victim to social media and mobile phone scams, fake charities and lotteries, dating and romance scams, and many other schemes used to defraud Canadians of their money and personal information.
