The Insurance Fraud Problem

Insurance fraud is one of the most costly white-collar crimes in America, second only to tax evasion. It affects every citizen of our state in an immediate and substantial way.

While shoplifting costs the retail industry approximately $13 billion each year, insurance fraud is estimated to cost $100 billion. In both instances, the crimes translate into higher costs for everyone. Insurance researchers estimate that every U.S. household pays $200 to $300 a year in higher premiums in order to offset fraudulent claims.

What does fraud look like?

Insurance fraud occurs when someone tries to make money from insurance transactions by deceiving others. Insurance fraud is a criminal offense in Kansas. The following list highlights examples of insurance fraud along with a brief description.

Insurance fraud falls primarily into two categories: internal and external.


Vehicle Scams


Agent Fraud

  • Conversion
  • Falsified/Forged Documents
  • Faked Policies, Certificates, Identification Cards, Binders
  • Misrepresentations to the Kansas Department Of Insurance
  • Pocketed Premiums

Arson/Suspicious Fire

  • Commercial Property Fire
  • Cover Up Suspicious Activity
  • Home/Residential Fire
  • Water Damage

Auto Bodily Injury

  • Adjuster, Agent, Claimant Rings
  • Claimant Rings (Nonprovider)
  • False Documents
  • Fake Injuries
  • Inflated Injuries
  • Jump-Ins
  • Opportunistic Injuries
  • Provider Rings

Auto Property

  • Body Shop Fraud
  • Chop Shops
  • Fake Damages
  • Forged/Faked/Altered Insurance Cards
  • Forged/Falsified Documents
  • Glass
  • Inflated Damages
  • Owner Giving Up/Ditching
  • Paper Accidents
  • Past Postings
  • Phantom Vehicle
  • Prior Damage
  • Property Theft from Vehicle
  • Staged Theft(s)
  • Vehicle Arson
  • VIN Switch
  • Vehicle Theft
  • Vehicle Vandalism

Commercial Auto

  • Staged/Caused Accidents

Commercial Property

  • Farm Loss
  • Staged Theft

General Liability

  • Broken Tooth Caper
  • Forged/Falsified Documents
  • Slip and Fall

Homeowner

  • Faked/Exaggerated Injury
  • Forged/Falsified Documents
  • Faked Loss of Personal Property
  • Inflated Claim
  • Inflated Injuries
  • Past-Posting
  • Phony Burglary
  • Phony Theft
  • Phony Vandalism
  • Staged Accident/Injury

Internal Fraud

  • Agent, Adjuster, or Personnel Claim Rings
  • Bogus Insurers (Unauthorized)
  • Embezzlement
  • Forged/Falsified Documents
  • Premium Fraud

Life

  • Beneficiary Not Entitled to Benefits
  • Faked Death
  • Forged Policy
  • Murder-For-Profit
  • Fraudulent Application

Medical/Health

  • Billing/Coding
  • Disability
  • Durable Medical Equipment
  • False Treatment
  • Forged/False Documents
  • Food Contamination
  • Foreign Object in Food/Drink
  • HMO Patient Screening
  • Home Health Care
  • Inflated Billing/Coding
  • Lab Scams
  • Medical Equipment
  • Pharmacy
  • Personal injury Mill
  • Self-Induced Injuries for Gain
  • Slip and Fall
  • Unbundling
  • Unnecessary Treatment

Workers' Compensation

  • Business Failure to Insure
  • Double-Dipping (Working while receiving workers' compensation benefits)
  • Excessive Charges/Unnecessary
  • Fake Injuries
  • False and/or Misclassification Reporting
  • False Loss Statements
  • Injury Unrelated to Work
  • Malingering
  • Prior Injuries
  • Personal Injury Mill
  • Premium Avoidance
  • Professional Claimants
  • Staged Accident
  • Theft by Insurance Agent

 

Next: How to Report Insurance Fraud >>