False insurance claims: Difference between revisions
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#REDIRECT [[Insurance fraud]] |
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'''Insurance fraud''' or '''false insurance claims''' are [[insurance]] claims filed with the intent to [[fraud|defraud]] an insurance provider. |
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In the United States insurance fraud is estimated to cost [[US$]]875 per person per year with [[The Coalition Against Insurance Fraud]] estimating the loss to be $80 billion per year and Medicare estimating fraud in its system costs the government $179 billion per year. |
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Some memorable examples of insurance fraud include the following: |
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* Former British Government minister [[John Stonehouse]] went missing in 1974 from a beach in Miami. He was discovered living under an assumed name in [[Australia]]. |
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* Derek Nicholson and Jottie Nagle were accused of attempting to defraud a [[life insurance]] company for $1 million after Mr Nicholson apparently went missing in [[New Jersey]] in July 2003 and Ms Nagle reported him missing and made a claim on the policy. |
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* Gaylan Sweet of [[San Diego]], [[California]], who was a claims adjuster for [[Allstate]] Insurance set up a scheme in 2002 that included non-existent children who were killed in hit-and-run auto accidents at non-existent intersections by phantom drunk drivers. Sweet and two others (who posed as the parents of the non-existent children) pocketed $710,000 before being caught by Allstate. |
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==Health insurance fraud== |
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Health insurance fraud is described as an intentional act of deceiving, concealing, or misrepresenting information that results in [[health care]] benefits being paid to an individual or group. |
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Member fraud consists of ineligible members and/or dependents, alterations on enrollment forms, concealing pre-existing conditions, failure to report other coverage, [[prescription drug]] fraud, and failure to disclose claims that were a result of a work related injury. Provider fraud consists of claims submitted by bogus physicians, billing for services not rendered, billing for higher level of services, [[diagnosis]] or treatments that are outside the scope of practice, alterations on claims submissions, and providing services while under suspension or when license have been revoked. [[Independent medical examinations]] are used to de-bunk false insurance claims and allow the insurance company or claimant to seek a non-partial medical view for injury related cases. |
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In response to the increased amount of health care fraud in the United States, [[United States Congress|Congress]], through the [[Health Insurance Portability & Accountability Act]] of 1996 (HIPAA), has specifically established health care fraud as a federal [[criminal offense]] with punishment of up to 10 years of prison in addition to significant financial penalties. |
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==External links== |
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* [http://news.bbc.co.uk/2/hi/americas/3734274.stm BBC article] |
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* http://www.insurancefraud.org |
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* http://www.insurancejournal.com/news/west/2002/12/20/25075.htm |
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* [http://www.nhcaa.org http://www.nhcaa.org] |
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*[http://www.carsnaps.com/articles.php?id=38 What is Auto Insurance Fraud and How to Prevent it?] by CarSnaps (2006) |
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*[http://www.johncooke.com John Cooke Fraud Report] |
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*[http://www.fightfraudamerica.com www.fightfraudamerica.com] |
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[[Category:Fraud]] |
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[[Category:Insurance terms]] |
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[[de:Versicherungsbetrug]] |
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[[nl:Verzekeringsfraude]] |
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Latest revision as of 11:07, 19 November 2012
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