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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Insurance fraud hurts the average person in two ways. First, all fraud costs, including losses, investigations, etc., are paid for by the insured through higher premiums, or, in the case of government insurance like Medicare, in higher taxes. Second, if a particular individual is the target for the fraud, they have costs such as deductible payments, loss of property use, etc., as well as higher premiums from the claim loss and the potential for denial of future coverage. |
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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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Studies show that over $30 billion is lost each year to health care fraud in the [[United States]]{{Fact|date=July 2007}}. In order to control costs, insurance companies have found it necessary to investigate fraud for the benefits of the members. |
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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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