Fraud

Examples of Auto Insurance Fraud include:

Staged accidents, where one or more criminals cause intentional collisions in order to get undeserved payments for health care costs for alleged injuries or vehicle damage.
Providing false information to an insurance company about a car's mileage or use.
Phony injury claims, when people lie about the injuries they have sustained in an accident.
Inflated damage claims, in which criminals falsify the extent of damage or the true cost of repairs to their vehicles.
Phony thefts, where the owner simply abandons a vehicle and then claims it was stolen.
Falsely claiming a one-car accident was a "hit and run."
Inventing injuries to people who were not in a vehicle at the time of the accident.

Examples of Homeowners' Insurance Fraud:

Staging a phony burglary or vehicle break-in and faking a loss.
Overstating the value of stolen items after an actual burglary of a home or vehicle.
Lying about the extent, cause, date or location of legitimate damage.
Intentionally damaging property.
Making a second claim for a loss that was already paid for by another insurer or through a prior claim.
Asking a repairman to "cover your deductible" within their estimate.
Fabricating supporting evidence - often in collusion with a crooked contractor, plumber, repairman or insurance adjuster.

Examples of Health Insurance Fraud:

Doctors billing insurers for a more costly service than the one performed.
Providing services such as tests, surgeries or other procedures that are not medically necessary to get additional payment.
Billing for services not actually rendered.
Billing each state in a procedure as if it were a separate procedure.
Accepting kickbacks for referrals.
Organized criminals setting up a phony clinic solely to generate fraudulent claims.
Patients forging receipts to get unwarranted reimbursement from an insurance company.
Patients embellishing, adding to or just plain lying about services received.
Patients who ask their doctors to falsify a report to an insurer to cover a non-covered procedure.
Patients who ask a doctor to waive their copayments.

Examples of Workers Compensation Insurance Fraud:

An employer misrepresents the amount of payroll or classifications of employees.
An employer attempts to avoid a higher insurance risk modifier by transferring employees to a new business entity rated as a lower risk category.
A worker who works full time at an unreported job and draws benefits when he or she is supposed to be unable to work, or when a worker fakes an injury.
a health care provider or attorney who assists the worker in fraudulent schemes, or participates in double billing or billing for services not provided.

Examples of Insurance Scams:

The insurance company in question boasts low rates, or offers minimal or no underwriting.
The health plan will accept almost anyone, including those with pre-existing or serious illnesses.
The agent (or information they provide) claims that the plan is covered only by stop-loss.
The plan claims to be federal, not state regulated. (ERISA or Union plans, for example)
Be skeptical if the premiums seem low compared with other health insurance plans.
Beware of sales material and pitches that avoid the word "insurance," or the use of certain insurance terminology even though it operates like insurance. For instance, it pays "consultant fees" instead of commissions, or refers to premiums as "contributions."
The product claims to be "fully funded," "fully insured," or "reinsured" but agents are not told the name of the carrier insuring or underwriting the product.