Arson is a complex crime with a significant risk of injury or death to innocent people and firefighters. Does it matter if the intention of the fire was to injure, or to commit insurance fraud, or if a person just left a campfire burning on a camping trip during a drought? When people understand that the consequences of their insurance fraud have suddenly become significantly more dangerous, with property damage outside of themselves or with people injured or killed, they attempt to cover up actions or intentions and are less forthcoming with investigators. But the consequences of this serious crime need to be understood, and the fact become known to the public record. Victims deserve the truth.
Health insurance fraud has been on the rise among both providers of student health insurance schemes and those engaged in efforts to obtain and use identifying health insurance information. Student or university-based health insurance is required for students at both public and private universities; international students are required to have local insurance for their visa applications, and local students have to go through a lengthy process of waivers if they want to use another health insurance option, such as a parent’s or spouse’s insurance. An unfamiliarity with the workings of the complex third-party system of insurance reimbursement cause many students to skip reading their medical statements and trying to decipher their meaning. This common practice has helped the fraudulent providers, who are not caught unless identified and reported through careful investigation of patterns of behavior.
Insurance is about trust, as much as it is about money. People who buy insurance need to be able to trust that providers will cover them. Providers need to be able to trust clients that their claims are genuine. If you’re looking at claims, here are some red flags you need to keep an eye out for in claims investigations.
For most people, they think that insurance fraud is insurance fraud anyway you look at it. However, both insurance companies and insurance investigators know that fraud comes in two forms – hard and soft. These two forms, while similar in the crime that is committed, often require very different investigation techniques in order to catch the fraudulent party and prove their crime.
When an insurance company looks into a claim, often they rely on statistical analysis and other data analysis techniques to flag potentially fraudulent cases. However, while this can point to potential insurance fraud, it certainly can’t prove it. Even in this digital age, the task of gathering proof for insurance fraud still falls to the investigators. However, no matter how simple or complex a case of insurance fraud may be, an investigator always has more than a few tried and true techniques for investigating at their disposal.