Insurance Fraud
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Insurance Fraud Casebook
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Author : Laura Hymes
language : en
Publisher: John Wiley & Sons
Release Date : 2014-07-22
Insurance Fraud Casebook written by Laura Hymes and has been published by John Wiley & Sons this book supported file pdf, txt, epub, kindle and other format this book has been release on 2014-07-22 with Business & Economics categories.
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.
Tackling Insurance Fraud
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Author : Lynne Skajaa
language : en
Publisher: Taylor & Francis
Release Date : 2020-11-25
Tackling Insurance Fraud written by Lynne Skajaa and has been published by Taylor & Francis this book supported file pdf, txt, epub, kindle and other format this book has been release on 2020-11-25 with Law categories.
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.
Broken Promises
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Author : Robert Tillman
language : en
Publisher: UPNE
Release Date : 1998
Broken Promises written by Robert Tillman and has been published by UPNE this book supported file pdf, txt, epub, kindle and other format this book has been release on 1998 with Business & Economics categories.
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.
Insurance Fraud Volume Ii
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Author : Barry Zalma
language : en
Publisher:
Release Date : 2019-10-31
Insurance Fraud Volume Ii written by Barry Zalma and has been published by this book supported file pdf, txt, epub, kindle and other format this book has been release on 2019-10-31 with categories.
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.
Global Pirates
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Author : Robert Tillman
language : en
Publisher: UPNE
Release Date : 2002
Global Pirates written by Robert Tillman and has been published by UPNE this book supported file pdf, txt, epub, kindle and other format this book has been release on 2002 with Business & Economics categories.
A critical investigation of international insurance fraud.
Psychological Drivers Of Insurance Fraud
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Author : Carolin Hutterer
language : en
Publisher: GRIN Verlag
Release Date : 2018-04-19
Psychological Drivers Of Insurance Fraud written by Carolin Hutterer and has been published by GRIN Verlag this book supported file pdf, txt, epub, kindle and other format this book has been release on 2018-04-19 with Business & Economics categories.
Master's Thesis from the year 2017 in the subject Business economics - Miscellaneous, grade: 1,3, LMU Munich (Munich School for Management), course: Executive Master of Insurance, language: English, abstract: The following master thesis covers the psychological drivers of insurance fraud. In this scientific paper it shall be explained how insurance fraudsters try to vindicate their behavior and which forms of reasoning are therefor used. Insurance fraud itself is defined as a fraud to the detriment of an insurance company by the policy holder or a third party with the aim of obtaining unjustified coverage, demanding a false payment of damages on the merits or to the extent of paying a lower insurance premium. The fraudulent behavior starts with consciously inaccurate information during application and extends up to manipulation in the context of loss. The legal consequences of insurance fraud are the same as of any other fraudulent behavior, like a fine or a short period of imprisonment. Furthermore the insurance company can claim indemnity demands or recourse or the insured can lose his coverage. It is reckoned that the annual losses of German insurance sector caused by insurance fraud are four billion Euro and that especially in the line of automobile insurance approximately every tenth notification of claim bases on fraudulent background. About 90 percent of insurance brokers report that they already were in contact with fraudulent clients and a common line in the insurance branch states that each tenth notification of claim contains fraud and that ten percent of payments are based on unjustified or fraudulent declarations. In social context insurance fraud is a damage for all insured clients. A higher rate of fraudulent behavior leads to more payments and in conclusion to higher premiums. The increased niveau of premiums furthermore reduces the public welfare of the insured and often leads to smaller profits for the insurance companies. Thereby many small deceptions have a high impact on the insurance companies, because costs of prosecution of these smaller delicts bear no proportion to the outcome. Basically insurance fraud is not tolerated in society just as any other form of fraud. But on closer inspection and having a regard to the listed numbers concerning insurance fraud it becomes clear, that there exist different standards. In the Europe-wide European social survey 2010 87 percent of respondents declared that insurance fraud is wrong or absolutely wrong.
Defending Against Insurance Fraud Claims
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Author : West Group
language : en
Publisher: Aspatore Books
Release Date : 2011
Defending Against Insurance Fraud Claims written by West Group and has been published by Aspatore Books this book supported file pdf, txt, epub, kindle and other format this book has been release on 2011 with Law categories.
Defending Against Insurance Fraud Claims provides an authoritative, insiders perspective on best practices for aiding insurers in handling fraudulent claims. Featuring partners from some of the nations leading law firms, these experts offer strategies for establishing and implementing successful research and investigative techniques, as well as assisting insurers in preventing fraud in the future. These top lawyers provide advice for consulting experts in the field, preparing for and conducting an examination under oath, and effectively collecting and presenting key evidence. From identifying helpful resources to requesting appropriate information, these authors discuss the increasing importance of using technology and social media in the initial research process and how it can ultimately affect the outcome of a case. The different niches represented and the breadth of perspectives presented enable readers to get inside some of the great legal minds of today, as these experienced lawyers offer up their thoughts around the keys to success within this ever-evolving area of law.
Insurance Fraud
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Author :
language : en
Publisher:
Release Date : 2003-01-01
Insurance Fraud written by and has been published by this book supported file pdf, txt, epub, kindle and other format this book has been release on 2003-01-01 with Insurance crimes categories.
Insurance Fraud Volume I Second Edition
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Author : Barry Zalma
language : en
Publisher: Independently Published
Release Date : 2022-03-12
Insurance Fraud Volume I Second Edition written by Barry Zalma and has been published by Independently Published this book supported file pdf, txt, epub, kindle and other format this book has been release on 2022-03-12 with categories.
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.
Marine Insurance Fraud
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Author : Baris Soyer
language : en
Publisher: Informa Medical
Release Date : 2012-12
Marine Insurance Fraud written by Baris Soyer and has been published by Informa Medical this book supported file pdf, txt, epub, kindle and other format this book has been release on 2012-12 with Marine insurance categories.