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Have You Been A Victim Of Health Insurance Fraud?

Health insurance fraud is an everyday occurrence and it can be extremely difficult to protect yourself against it. Indeed, the majority of policyholders who fall victim to health insurance fraud are not aware of the fact until it comes to make a claim. It's not until that claim is denied that they realize that they have joined the growing number of victims of this particularly nasty form of fraud.

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So, is it possible to stop yourself from becoming a victim of health insurance fraud?

The problem is that there are almost as many different forms of insurance fraud as there are victims and so spotting it can be very difficult. There is however one thing that should always make you suspicious and that is the offer of excellent coverage and a very low price. Medical costs are rising alarmingly and so is the cost of health insurance so, when somebody offers you a policy at a very low cost, tread warily.

Be particularly suspicious of unsolicited mail that offers discounted health insurance, especially if you do not recognize the name of the company that is making the offer. At this point your first step should be to do a little research on the company and you will find that health insurance companies are both listed and rated at http://www.ambest.com/. It is also a good idea to check with your State Insurance Commission to see whether the company has been granted a license to operate in your state.

If the offer appears to be genuine then read it in its entirety and pay particular attention to the fine print. The fine print, covering such things as exclusions, may turn a seemingly great offer into one that is potentially very costly. If a salesperson calls with an offer then you should also be very suspicious of any request to pay by cash or to pay the total amount of your premium in advance.

If you discover that you have become a victim of health insurance fraud then you should take the following steps without delay:


Contact your State Insurance Commissioner to discover if he has had any other complaints about the company in question and to file a health insurance fraud complaint.


Contact your bank or credit card company and put a stop on any future payments that may be scheduled.


Contact your local law enforcement agency.


You should also gather together any cancelled checks or credit card statements and a copy of the health insurance contract that you signed, together with any correspondence, to assist in any investigation.

Unfortunately this may not be the end of the matter but could be just the start, as many people who perpetrate health insurance fraud also use your personal information to steal your identity and to commit other fraudulent acts. So, you should also get a copy of your personal credit report from all three major credit reporting agencies as soon as possible and watch carefully for any signs of irregular financial transactions being carried out in your name.

Identify fraud is a major subject in its own right and beyond the scope of this article but, if you have been the victim of health insurance fraud, it is an area on which you should seek further advice.

Be careful and check out any health insurance company before you sign on the dotted line. You can never be too careful and, in addition to the checks suggested above, you should think about such things as asking others if they have ever heard of the company in question. This might include asking your doctor or local hospital. If they say that they won't accept insurance from the company, and indeed have never heard of it, then this should set bells ringing.

State governments take an especial interest in health insurance companies and often have their own rules for the sale of insurance within the state. In many cases this is particularly advantageous to policyholder as is the case with affordable California health insurance so, if you are looking for a low cost health insurance plan then it's often a good idea to check out your own state's policy first.


Fraud occurs when someone knowingly lies to obtain some benefit or advantage to which they are not otherwise entitled or someone knowingly denies some benefit that is due and to which someone is entitled. Depending on the specific issues involved, an alleged wrongful act may be handled as an administrative action by the Department of Insurance or the Fraud Division may handle it as a criminal matter.

What Types of Insurance Fraud or Other Crimes Does the Fraud Division Handle? Current law requires the Fraud Division to investigate various felony provisions of the Penal and Insurance Codes. Most often, investigations conducted by the Fraud Division involve some aspect of a "Suspected Fraudulent Claim" or other related crimes.

Cases investigated by the Fraud Division most often involve criminal acts involving automobile property and personal injury, workers' compensation, health insurance and residential and commercial property claims.

State and federal laws also permit the Fraud Division to pursue its cases federally. In those instances, the crime of "insurance fraud" is usually pursued as "mail fraud," "criminal racketeering" or other federal offenses.

Impact of Fraud:

Insurance fraud is estimated per year to be $27.6 billion. Automobile fraud $12.3 billion, business and commercial $1.8 billion, homeowner fraud $1.8 billion and life/disability fraud $1.5 billion.

Insurance fraud, the white collars second most costly offense, costs the American public approximately 96.2 billion dollars per year in increased premiums alone. A study in 2001 by Conning and Co. estimated that insurance fraud increases the average American household costs by over $5000.00/year when the rise in premiums, goods and services are taken into consideration.

Homeowner fraud which includes property and casualty claims total a sum of about $30 billion per annum. (Insurance Information Institute)

False claims in the American healthcare system cost the U.S. an approximate $54 billion a year. (CAIF)

In Canada, 10-15% of claims paid out are fraudulent. The sum of general insurance fraud inflates costs an estimated $1.3 billion per year according to the CCIAF.

In order to further investigate the specific regulations in your State and assess whether you would like to pursue a possible offense, the following link will offer you the Contact Information for the authorities in your State: State Department of Insurance Contact Information

In the United States auto insurance fraud is becoming one of the biggest fraud problems this country is faced with. In this article we're going to discuss some of the more common auto insurance fraud scams and what somebody can do to prevent them.

Today one of the most popular insurance fraud scams involves auto insurance and auto accidents. More specifically, staged auto accidents. These have actually become quite complex to the point where they involve multiple participants. There are many variations of these. We'll cover the main ones here.

First there is what is called the swoop and squat. This scam involves three vehicles. Two are driven by the criminals and the third is driven by the victim. The driver of the "squat" vehicle positions himself in front of the victim. The person driving the "swoop" vehicle pulls ahead of the squat vehicle and intentionally cuts the vehicle off. This causes the driver of the squat vehicle to slam on his brakes and stop short. Usually, the victim can't react quickly enough and rams into the squat vehicle. In the meantime, the swoop vehicle that caused the accident takes off and is never seen again. The victim tells police that the swoop vehicle caused the accident, but because that vehicle can't be located the victim ends up having to pay for the damage and any personal injury claims.

Then there is what is known as the side swipe. This type of accident usually happens at busy intersections with dual left hand turn lanes. The criminal positions his vehicle in the outer left turn lane. When the victim's vehicle drifts into the outer turn lane the criminal side swipes him. To make sure the scheme works the criminal does preliminary surveillance to make sure that the intersection is busy enough where drifting will occur because of the amount of traffic.

Another common auto accident scam is what is known as the Panic Stop. In this scheme the criminal drives a late model car filled with a lot of passengers. The criminal will then position himself in front of the victim and have one of the passengers look out the back window watching to see for any signs of distraction such as answering a cell phone call or changing a station on the radio. Any sign that the victim is taking his eyes off the road. Once this happens the passenger signals the driver who then slams on the brakes thus causing an accident. The victim will claim that the criminal stopped short for no apparent reason but usually to no avail. In the meantime the victim has to pay for all damages and injuries reported.

Unfortunately there is only one way to avoid these type of accidents and that is to be observant at all times and keep a safe distance from any vehicle ahead of you. The sad truth is, if all motorists would just obey the speed and distance laws and rules, accidents like these would never happen. But people drive too fast and too close and thus these type of frauds will always be pulled off. Drive safe and smart and your chances of being the victim of auto insurance fraud will be greatly diminished.

 

 

 

 

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