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Insurance Fraud Numbers in the US

January 3, 2017 by  
Filed under Blog

You can put stock in one industry to do well despite the recession, but it’s unlikely to show up on the NYSE. Insurance fraud has been the favored crime for unethical white-collar workers looking to fake injuries, and they’ve also began denting their cars, to claim a quick bundle. According to the National Insurance Crime Bureau (NICB), questionable claims went up by 27% between 2010 and 2012. That figure breaks down to 9% between 2010 and 2011, and 16% between 2011 and 2012. Insurance fraud investigators must have had a heyday.

Rising fraud insurance claims is hardly a US phenomenon. In the UK, bogus car insurance claims went up by 20% since 2012. Fake car crashes led to a combined fraud of £811m in 2013, with the total fraud up by 18% over the previous year.

Regional winners

The cities with the highest levels of insurance fraud were New York with 13,564 questionable claims, Los Angeles with 7,779, Miami with 5,503, Houston with 5,464, and Baltimore with 3,690.

State-wise, California lead the way by a huge margin with 58,415 suspected cases of fraud from 2010 to 2012. Following were Florida with 29,086 cases, Texas at 27,107, New York at 23,402, and Maryland at 10,315. Population-wise, the states most vulnerable to insurance fraud were Kentucky, where suspected fraud levels rose by 89%, Vermont by 88%, Rhode Island by 81%, Alaska by 75%, and Maryland by 70%.

Popular schemes

Said to be the easiest kind of insurance fraud, deliberately damaged cars made up the bulk of nationwide fraud cases, with 209,724 suspected fraud claims. Home insurance was the second most common source of insurance scam, with 40,747 questionable claims, after which worker salary and liability policy scams accounted for 11,151 cases. Commercial car and liability insurance generated a combined 17,031 cases. However, fire insurance and personal property insurance companies breathed a little easy, since they saw the number of questionable claims drop slightly from 2010 to 2012.

Those slipping and falling their way to insurance claims were under the radar, with insurance companies referring over 50,000 cases to the NICB and surveillance investigators for review. Also under scrutiny were questionable theft of heavy equipment and vehicles with 35,508 questionable claims, miscellaneous property damage or prior loss at 29,646 claims, suspicious loss of miscellaneous belongings at 29,017 claims, and suspicious loss or theft of belongings at 24,867 claims.

Insurance scams are common because instigators often encourage customers and family members to use them to save some money, making the scams look easy. As a result, innocent insurance customers have to pay higher rates and premiums. If you suspect or know someone of participating in insurance fraud, don’t be an onlooker – inform the authorities.

Get Our Free Newsletter Join 10,000+ of your peers! Get our latest WorkersCompensation.com articles delivered to your email inbox for free Full name: Email: Home | News | Central Florida Man Who Lied About On The Job Injury Lands In Jail Central Florida Man Who Lied About On The Job Injury Lands In Jail

December 29, 2016 by  
Filed under Blog

 

Orlando,FL.(WorkersCompensation.com)  – The Department of Financial Services’ Division of Investigative and Forensic Services (DIFS), which operates under the direction of CFO Jeff Atwater, today announced the arrest of Orlando resident Ricardo Aponte on workers’ compensation fraud charges following an elaborate scam involving an alleged on-the-job injury. Aponte claimed to have suffered a work-related neck injury that prevented him from bending his body and prohibited him from working. As a result, Aponte’s employer paid more than $500,000 in medical and lost-wage costs related to the supposed injury.
After the employer’s insurance company raised suspicions that Aponte might be lying, DIFS insurance fraud detectives launched an investigation to verify the legitimacy of Aponte’s claim and to learn more about his day-to-day activities.
The investigation revealed that Aponte’s injury was first reported in January 2007. During the course of the claim, he received medical treatments from multiple physicians and was provided a motorized wheelchair and a cane to assist with the pain he suffered in his back, legs, and upper torso. Years later, in May 2016, Aponte again swore under oath that he could not work and that the assistance of medical equipment was required to perform even the simplest day-to-day tasks.
However, insurance fraud investigators secured video surveillance that proved otherwise. On multiple occasions, Aponte was seen moving about without the support of any medical devices whatsoever. In one instance, Aponte was recorded cleaning his boat and preparing it for travel. In another, he was seen physically pushing the boat off its trailer and into the water.
He was arrested and taken to the Orange County Jail. He has been charged with workers’ compensation fraud, false statements in support of a claim, false and fraudulent insurance claims, and grand theft. This case will be prosecuted by the Office of State Attorney Jeffrey L. Ashton and if convicted, Aponte could be forced to repay his employer in full, pay a $10,000 fine and spend up to 30 years in prison.

When do you Require Undercover Investigation?

December 27, 2016 by  
Filed under Blog

There can be a number of situations in everyday business that require owners to seek the help of private investigations firms. But some of these situations can be a bit too much for ordinary investigators and require a firm that has extensive experience with unorthodox investigative techniques, like undercover investigations.

NSIU has highly trained and certified investigators on board that have extensive experience in conducting undercover investigations. If you are wondering what kinds of situations require an undercover investigation, then you should peruse the following information:

Drugs at the Office

If you suspect that your employees have been using or distributing drugs at the office, then an undercover surveillance operation is what you require. NSIU’s investigators are skilled and have the ability to blend into any type of environment. They will conduct their investigation swiftly and bring you the evidence that you require.

Theft or Embezzlement

Financial matters are another reason business owners may request an undercover investigative service. It can be because of theft of company funds or equipment, whether external or internal, and when someone is embezzling company funds.

Sabotage

Some nefarious elements can try and harm your company or employees, for the purpose of sabotaging your organization. In this type of a situation, an undercover investigator can be exactly what you need to identify the saboteurs.

Information Leak

Data and electronic information is one of the most valuable things that modern businesses have. If someone is leaking information, either inadvertently or on purpose, then an undercover investigation can reveal the relevant party.

Security Gaps

When a business deals in sensitive materials or information, keeping the whole facility secure is the owner’s number one priority. Undercover investigators can take a deep look at the security procedures at your company and how they are being implemented.

Operational Hurdles

This isn’t a very common reason for starting an undercover investigation at your company, but it isn’t unheard of. To find out if something or someone is hindering the production process in your organization, you can request an undercover investigation.

These are the most common reasons that require undercover investigations in an organization. If you are dealing with a similar situation at your place of work, then contact NSIU and request an undercover investigation immediately.

About the Company

National SIU (Special Investigation Unit) is a professional investigation firm that specializes in surveillance and other services specifically for risk managers and insurance professionals. The organization’s main goal is to provide their clients with effective evidence which can be used to uncover the truth.

For more information, please visit http://www.nsiu.com/home

 

‘Injured’ Verizon worker pleads guilty in Workers Comp scam

December 22, 2016 by  
Filed under Blog

A Staten Island phone worker pleaded guilty to stealing more than $37,000 in workers’ compensation benefits by claiming job-related injuries — while he taught kickboxing.

Eugene Reems, 49, of Colony Avenue, pleaded guilty in Staten Island Supreme Court, state Inspector General Catherine Leahy Scott and Staten Island District Attorney Mike McMahon said Tuesday.

Reems began receiving benefits after he said he was hurt in 2007 while working as a lineman for Verizon on Staten Island.

But in 2012, he began teaching martial arts at CKO Kickboxing on Westerleigh, a business that was opened by his wife and a cousin, an investigation by Leahy Scott found.

While working at the school through May 2014, Reems was caught on surveillance video performing powerful kicking and punching moves, although he told doctors at the time that he was unable to work.

“The defendant’s repeated assertions that he was physically unable to work as a telephone company lineman, while at the same time demonstrating kicks and power punches as a martial-arts instructor, was a brazen fraud perpetrated on a critical safety net meant for honest, hardworking New Yorkers,” Leahy Scott said.

McMahon said, “While collecting disability checks, this defendant was found to be perfectly capable of earning an income on his own.”

Reems, who couldn’t be reached for comment Tuesday, has agreed to pay $37,500 in restitution and has forfeited any future workers’ compensation benefits.

Workers’ compensation fraud impacts all New Yorkers, from increased insurance premiums to increased work loads for coworkers and an overall reduction in workforce productivity, Leahy Scott said.

Insurance Fraud Numbers in the US

December 20, 2016 by  
Filed under Blog

You can put stock in one industry to do well despite the recession, but it’s unlikely to show up on the NYSE. Insurance fraud has been the favored crime for unethical white-collar workers looking to fake injuries, and they’ve also began denting their cars, to claim a quick bundle. According to the National Insurance Crime Bureau (NICB), questionable claims went up by 27% between 2010 and 2012. That figure breaks down to 9% between 2010 and 2011, and 16% between 2011 and 2012. Insurance fraud investigators must have had a heyday.

Rising fraud insurance claims is hardly a US phenomenon. In the UK, bogus car insurance claims went up by 20% since 2012. Fake car crashes led to a combined fraud of £811m in 2013, with the total fraud up by 18% over the previous year.

Regional winners

The cities with the highest levels of insurance fraud were New York with 13,564 questionable claims, Los Angeles with 7,779, Miami with 5,503, Houston with 5,464, and Baltimore with 3,690.

State-wise, California lead the way by a huge margin with 58,415 suspected cases of fraud from 2010 to 2012. Following were Florida with 29,086 cases, Texas at 27,107, New York at 23,402, and Maryland at 10,315. Population-wise, the states most vulnerable to insurance fraud were Kentucky, where suspected fraud levels rose by 89%, Vermont by 88%, Rhode Island by 81%, Alaska by 75%, and Maryland by 70%.

Popular schemes

Said to be the easiest kind of insurance fraud, deliberately damaged cars made up the bulk of nationwide fraud cases, with 209,724 suspected fraud claims. Home insurance was the second most common source of insurance scam, with 40,747 questionable claims, after which worker salary and liability policy scams accounted for 11,151 cases. Commercial car and liability insurance generated a combined 17,031 cases. However, fire insurance and personal property insurance companies breathed a little easy, since they saw the number of questionable claims drop slightly from 2010 to 2012.

Those slipping and falling their way to insurance claims were under the radar, with insurance companies referring over 50,000 cases to the NICB and surveillance investigators for review. Also under scrutiny were questionable theft of heavy equipment and vehicles with 35,508 questionable claims, miscellaneous property damage or prior loss at 29,646 claims, suspicious loss of miscellaneous belongings at 29,017 claims, and suspicious loss or theft of belongings at 24,867 claims.

Insurance scams are common because instigators often encourage customers and family members to use them to save some money, making the scams look easy. As a result, innocent insurance customers have to pay higher rates and premiums. If you suspect or know someone of participating in insurance fraud, don’t be an onlooker – inform the authorities.

Some Easy Tips to Take Insurance Frauds under Wings

December 19, 2016 by  
Filed under Blog

According to insurance fraud statistics, a large number of people are being scammed by various frauds. A large number of people who applied for policies later found out that they have paid bogus premium amounts. They have become the victim of health insurance frauds and other types of policy frauds.

At NSIU it our responsibility to ensure that our clients stay protected from all types of insurance frauds. As a leading private investigation firm, we are proud to have protected a number of different clients against insurance frauds and helped them secure their rights.

Coming in from our top surveillance experts, here are a few tips you can use to protect yourself against insurance frauds:

Know the insurance carrier

First things first, you need to know the company you are dealing with inside out. Many policy buyers are easily attracted to packages that are not just affordable but seem to offer more benefits. Unfortunately, many of them could be too good to be true.

Before you moving on to signing and making payments, make sure that you are dealing with a licensed service provider. Check whether the company is accredited by the state department of insurance. If it is not registered, you are most likely dealing with scammers.

Avoid paying cash

Always avoid paying in cash or expressing the fact that you can pay in cash. Especially if you have an agent, avoid making any payments in the form of cash. It is always better to pay through check and have the check named to the company you are dealing with. This practice will help you avoid instances where agents are looking to benefit personally from the policy buyer.

 

 

Yonkers Woman Pleads Guilty to $6,500 Workers’ Comp Fraud

December 15, 2016 by  
Filed under Blog

Albany, NY (WorkersCompensation.com) – New York State Inspector General Catherine Leahy Scott today announced the guilty plea of a Yonkers woman for stealing nearly $6,500 in Workers’ Compensation benefits to which she was not entitled.

Diane Lares, 38, of Woodworth Avenue, Yonkers, pleaded guilty in Yonkers City Court today to petit larceny, a misdemeanor. As part of the plea, Lares is expected to pay back $6,469 in Workers’ Compensation benefits she received but to which she was not entitled.

An investigation by Inspector General Leahy Scott found Lares sustained an injury in late 2014 after falling down stairs at a clothing retailer where she worked and began receiving Workers’ Compensation benefits. She testified at a New York State Workers’ Compensation Board hearing in March 2015 that she had not worked since November 2014. The investigation determined, however, that while she was receiving benefits she was regularly working as a bartender at a sports bar.

In addition, on two occasions, Lares filled out medical questionnaires in which she failed to mention her employment as a bartender and asserted that she was not working in any capacity.

During the first half of 2015, Lares collected $6,469 in Workers’ Compensation benefits to which she was not entitled.

Under New York State law, employers are required to maintain Workers’ Compensation coverage for their employees, and employees are expected to provide truthful information regarding their work activity to insurance carriers and the Workers’ Compensation Board during the time they are receiving benefits.

Workers’ Compensation fraud impacts all New Yorkers, from increased insurance premiums to increased workloads for coworkers and an overall reduction in workforce productivity.

Lares is due to return to Yonkers City Court March 30, 2017 for sentencing.

Inspector General Leahy Scott thanked the National Insurance Crime Bureau for their assistance with the investigation, and the offices of the Westchester County District Attorney for prosecuting this case.

5 Most Common Types of Insurance Frauds You Should Know Of

December 9, 2016 by  
Filed under Blog

Surprisingly, insurance fraud is viewed as a victimless offense. When insurance companies are cheated, it is the people who pay premium on a timely basis that suffer the most. This is because their insurance cost goes up. It’s saddening to know that the losses suffered by insurance companies because of perpetrators are in turn borne by honest people.

According to statistics, around $80 billion losses are incurred annually on account of insurance frauds.

However, not many people know that we, as individuals, can play an essential role in preventing insurance frauds. For this, we need to be aware of the most common types. Stated below are the 5 most common types of insurance frauds:

1.     Stolen Cars

Offenders make use of stolen cars to commit an insurance fraud in two ways. Firstly, if a legitimate owner sells the car to a body shop owner for spare parts, it could be considered stolen. Since the body shop is also a faction of the scheme, the legal authorities wouldn’t  be able to find out that an insurance fraud has been committed. Secondly, criminals hide their car and make claims that it has been stolen. Moreover, the insurance company wouldn’t be able to draw out money from the car owner even after the car is located.

2.     Car Accidents

Many of the accidents that happen around us are actually insurance frauds taking place. Insurance fraud accidents are staged where the driver and the victim are co-conspirators. Sometimes, the fraud is planned on such a massive level that it involves fake witnesses and insurance investigators as well. Moreover, in such fraud claims, the value of the car that got hit and the value of the car that hits the victim’s car are greatly hiked. Likely so, the cost of the damages is also inflated.

3.     Health Insurance Billing Fraud

It is quite appalling to know that healthcare professionals are often involved in such conspiracies. Some basic examples of common frauds they commit include billing the insurance company for treatments that was never provided, or hiking the value of the work that was done. For instance, if a patient comes in for a regular checkup, the doctor would bill the insurance company for an in-patient surgery. Here, the patient may be the real victim of fraud but would have no knowledge of it.

4.     Unneeded Medical Procedures

If you ever come across a situation where your doctor is prescribing you tests unnecessarily, or ones you feel don’t pertain to your condition, you might be a victim of insurance fraud. For example, if you are suffering from a leg sore and your doctor asks you to get some blood and stool tests done, you are likely to get confused as to the reason behind this test.

5.     Faked Death

This is one fraud that has stemmed from movies, books and TV shows. In such kind of insurance frauds, the criminal will file an insurance policy of his own life, making the spouse as the only beneficiary. After months, the fraudster will fake his/her own death and all the money and benefits will go to the spouse. Post funeral, the spouse may relocate where they reunite and enjoy the claimed money.

Have you been a victim of a ruthless insurance fraud? If yes, then you surely need the assistance of an insurance fraud investigator such as National SIU. This private investigations firm has a special investigations unit so that you can be provided with evidences that reveal the real side of the case. Browse their website http://www.nsiu.com/home for more information.

Dentist pleads guilty to $1M in Medicaid fraud

December 8, 2016 by  
Filed under Blog

An Atlanta-area dentist pleaded guilty Thursday to conspiring to commit healthcare fraud by filing nearly $1 million in false claims with the Georgia Medicaid program, according to the U.S. Department of Justice.

Dr. Oluwatoyin Solarin owned and operated the practice Care Dental with locations in Duluth and Doraville, U.S. Attorney John Horn said.

Solarin submitted false claims to the Georgia Medicaid Program and the Peach State Health Plan of Georgia Medicaid from 2009 through 2013, Horn said. The practice racked up $996,862.19 in fraudulent Medicaid claims, which she mostly used to buy real estate in metro Atlanta, according to the justice department.

“Various claims listed Solarin as the treating dentist on days that she was not even in the country,” Horn said.

She is said to have billed for patients who were ineligible for Medicaid services. When their eligibility expired, Solarin told an employee to backdate the claims so they would be paid.

“The costly effects of health care fraud touches every taxpayer in the state of Georgia, directing critical resources from those who truly need them,” Horn said.

As part of the plea agreement, Solarin must repay the money and forfeit her interest in over a dozen real estate properties.

“Criminals such as Solarin, who engage in healthcare fraud and target the most vulnerable, are among the worst,” said Derrick L. Jackson, Special Agent in Charge of the U.S. Department of Health and Human Services, Office of Inspector General in Atlanta.

Auto mechanic owes BWC $132,000 for workers’ comp fraud

December 2, 2016 by  
Filed under Blog

Manuel Perez, 59, of West Portsmouth in Scioto County, pleaded guilty Monday, Nov. 21, in the Franklin County Court of Common Pleas to misdemeanor counts of workers’ compensation fraud and theft. He paid $10,000 toward his restitution to BWC at his sentencing. He also was sentenced to six months in jail, which was suspended so long as he complies with the terms of his probation.

“This case took four long years to investigate and prosecute, and I’m proud our investigators pushed it forward,” said BWC Administrator/CEO Sarah Morrison. “Mr. Perez’s restitution will go where those funds rightfully belong – caring for injured workers and creating safer workplaces across this state.”

BWC’s Special Investigations Department (SID) got a tip in November 2012 that Perez was working for his own business, M A Perez Enterprises, as a mechanic while filing an application for permanent total disability benefits from BWC. The source reported that Perez was able to crawl underneath vehicles, push and pull equipment and use wrenches to repair vehicles.

Investigators found Perez had continued to operate his mechanic’s business during a period in which he also received temporary total benefits, September 2007 to November 2011. Agents obtained bank records that provided customer names and payments and receipts from an auto parts store totaling $43,000. The customers were interviewed and identified Perez as the owner/operator of the business.

Perez’s case took years to resolve as it made its way through BWC, the Ohio Industrial Commission (IC) and the court system.

Perez was injured in December 2002 while working for a construction company and was later granted injured workers’ benefits. Roughly four months after SID began its investigation in 2012, an IC hearing officer determined Perez was overpaid and had committed fraud because he operated his automobile repair business without telling BWC. Perez denied those findings and unsuccessfully appealed his case all the way to the Ohio Supreme Court.

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